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Caradavin · New User Joined: 27 Aug 2009 Posts: 2

Hello. Diagnosed June 5th, the day after my birthday. I knew something was wrong when my doc called during my bday party, the day after my biopsy. Things have been a bit of a blur since. Have had one D&C. I am 32. I am TTC. I am on provera, 20mg 2xday, and will soon be on monthly Depo shots as well as the Mirena IUD. I will also have a biopsy and/or D&C every three months, all of this for the next year. The good news is that it is early, and has only spread to the cervix by a fraction. I have already had a second opinion with an oncologist who backed up the diagnosis, and it's due to my PCOS/endometriosis issues that I've had since I was 17 or so. Even though it is early, my gyno states that the cancer has been growing for at least 5 years, so it must be a slow grower. Anyway, I am getting married in less than a year, and I really want to try all options before losing my uterus. Cancer is in my family - lymphatic, lung, uterine and on both sides. But I know in my heart that I am meant to have at least one child. Anyway, I do have one question - this provera is meant to help slough off my endometrium. However, I am on a twice daily dose. I was due for a period three days ago (and I had been bleeding for an entire month in June), but it doesn't seem to be anywhere near. Am I supposed to stop the Provera so I can have the period and then resume? Does anyone know? Glad to find this forum. Oh, and I have alternating days where I can't sleep at all or am so very tired I can't get out of bed - is that medicine, cancer, or both? Meh. Rolling Eyes

rmaureen · Moderator Joined: 06 Oct 2005 Posts: 237

Hi Caradavin,

Welcome to the forum Very Happy

. That's a lousy way for your birthday to go --let alone what you are now facing, but thankfully your cancer was caught in a very early stage. Have doctors disclosed the staging and the grade of the cancer? From what I gather your oncologist wants to try hormone therapy with Provera. Hormone therapy can be risky, it does not work for all women diagnosed---and I am referring to those staged early as they are the targeted candidates for it. I also was on Provera for bleeding which was believed caused by fibroids, (my doctors were clueless that I had cancer). Before I could have surgery for a hysterectomy, I had two emergency blood transfusions for loss of blood. Many emergency trips. Provera did not slow it down--yet then again--I have no ideal how far the cancer was when I initially started Provera--I think timing plays a major factor for considering it a viable option. For almost the last 1.5 years before my diagnosis, I bled heavily with huge clots daily. I also experienced great fatigue--I think more because of the amount of blood I was losing. All blood test ordered by my doctor indicated severe anemia.

I encourage you to call your doctor concerning your questions on your period. Also, you may consider seeking a second opinion on the best course of treatment for you. I am posting an excerpt from another post on this forum revolving around a conversation which describes treatment of uterine cancer ( Mayo Clinic is the source). Equip yourself with information and ask hard questions of your oncologists--I write my down because as you said well, your life becomes a blur in trying to deal with all of this. Hopefully others will post with similar experiences as yours and share their insights with you. Caradavin, you will be in my thoughts and prayers. Keep us informed about how you are doing, and about your treatments.

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This is taken directly from the Mayo Clinic website:
http://www.mayoclinic.com/health/endometrial-cancer/DS00306/DSECTION=treatments%2Dand%2Ddrugs

"Treatments and drugs
By Mayo Clinic staff

Surgery is the most common treatment for endometrial cancer. Most doctors recommend either the surgical removal of the uterus alone (hysterectomy) or, more likely, the surgical removal of the uterus, fallopian tubes and ovaries (hysterectomy with bilateral salpingo-oophorectomy). Lymph nodes in the area should also be removed during surgery along with other tissue samples.

A hysterectomy is a major operation, and because you can't get pregnant after your uterus has been removed, it can be a difficult decision for some women. However, surgery is usually the only way to eliminate the cancer or the need for further treatment.

If you have an aggressive form of endometrial cancer or the cancer has spread to other parts of your body, you may need additional treatments. These may include:

* Radiation. If your doctor believes you're at high risk of cancer recurrence, he or she may suggest that you have radiation therapy after a hysterectomy. Your doctor may also recommend radiation therapy if the cancerous tumor is fast growing, invades deeply into the muscle of the uterus or involves blood vessels. Radiation therapy involves the use of high-dose X-rays to kill cancer cells. When done from outside the body, it's called external beam radiation therapy. Brachytherapy is another form of radiation that involves the internal application of radiation, usually to the inner lining of the uterus. Brachytherapy has fewer side effects than conventional radiation therapy does. However, brachytherapy treats only a small area of the body.

*Hormone therapy. If the cancer has spread to other parts of your body, synthetic progestin, a form of the hormone progesterone, may stop it from growing. The progestin used in treating endometrial cancer is administered in higher doses than is used in hormone replacement therapy for menopausal women. Other medications may be used as well. Treatment with progestin may be an option for women with early endometrial cancer who want to have children and, therefore, don't want to have a hysterectomy. However, this approach is not without the risk that the cancer will return. Carefully discuss this treatment with an expert in this field.

Another hormone therapy option is gonadotropin-releasing hormone agonists. These drugs can lower estrogen levels in premenopausal women.

* Chemotherapy. Chemotherapy is the use of drugs to kill cancer cells. Often, chemotherapy drugs are used in combination to increase their efficacy. Generally, women with stage III or stage IV endometrial cancer will be offered chemotherapy as part of their treatment regimen. You may receive chemotherapy drugs by pill (orally) or through your veins (intravenously). These drugs enter your bloodstream and then travel through your body, killing cancer cells outside the uterus.

Each type of treatment for endometrial cancer can have side effects. Ask your doctor what side effects you can expect and what can be done to manage them.

If you have late-stage or recurrent endometrial cancer, you may benefit from participating in clinical trials that provide new experimental treatment options. For more information on clinical trials, contact the National Cancer Institute at 800-4-CANCER (800-422-6237) or visit its Web site.

After treatment for endometrial cancer, your doctor will likely recommend regular follow-up examinations to determine whether the cancer has returned. Checkups may include a physical exam, a pelvic exam, a Pap test, a chest X-ray and laboratory tests."

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Rhonda
_________________
Diagnosed Sept. 2005
Stage III-C Endometrial Adenocarcinoma
Grade 2

Caradavin · New User Joined: 27 Aug 2009 Posts: 2

Here is what I know:

Adenocarcinoma
serous papillary
been there a while
hyperplasia

early detection

I asked for the stage and grade and I get a mumbled result. I am not sure if it is because my doctor is Iranian and I'm not understanding him or if he is just not sure yet. I've asked three times now. He wants to just take out my uterus, but I refuse at the moment because I want children so very badly. I had miscarried (or I think I did) about three months before my diagnosis. It was my fourth miscarriage and I have no children. The treatment plan was created by him and the oncologist I consulted for a second opinion. The oncologist also did not give me a definite stage and grade. Is it just hard to tell without uterine removal?

rmaureen · Moderator Joined: 06 Oct 2005 Posts: 237

From what I gather, looking into credible medical websites, staging is done primarily through 2 methods: one through surgery by which tissue is removed during an operation. This staging method is called the FIGO Surgical Stages For Endometrial Cancer. The second method is done through tests and it is called FIGO Clinical Staging System. I am no doctor, but it seems very plausible someone diagnosed in an early stage may be able to get the pathology through a process in line with the FIGO Clinical Staging System. However, there appears be some cause for concern here, as you mentioned your doctor wants to take out your uterus. You should continue to push for answers, and I have learned the hard way to request copies of medical reports for my reference and personal benefit. I certainly sympathize with your desire to have children, however, you must press for answers by your medical team. I am sorry for the miscarriages you have suffered, but I personally feel you need to make the best decision which would increase your odds of beating this disease and minimizing the chances of it returning. Nevertheless, it is certainly a personal choice for each individual to how proceed in such cases. But I do think you should continue to push for answers, such as why he wants to remove the uterus, what stage its in, and what other treatments are available. More information on staging below:

According to oncologychannel.com--the follow information on its website states:

FIGO Surgical Stages For Endometrial Cancer

Stage I The tumor is confined to the uterine fundus (the body of the uterus).
Stage IA The tumor is limited to the endometrium (the lining of the uterus).
Stage IB The tumor invades less than one-half of the myometrial thickness (the myometrium is the muscular tissue that is found just beneath the endometrium).
Stage IC The tumor invades more than one-half of the myometrial thickness.
Stage II The tumor extends to the cervix (the lower part of the uterus).
Stage IIA Cervical extension is limited to the endocervical glands (glands in the inner lining of the uterus, where the cervix meets the uterus).
Stage IIB Tumor invades the cervical stroma (the supporting connective tissue of the cervix).
Stage III There is regional tumor spread.
Stage IIIA The tumor invades the uterine serosa (the layer of tissue that surrounds the outside of the uterus), or adnexa (tissues on either side of the uterus), or cells in the peritoneum (the member surrounding the abdominal cavity) show signs of cancer.
Stage IIIB Vaginal metastases are present.
Stage IIIC The tumor has spread to lymph nodes near the uterus.
Stage IV There is bulky pelvic disease or distant spread.
Stage IVA Tumor has spread to the bladder or rectum.
Stage IVB Distant metastases are present.

FIGO Clinical Staging System

Stage 1 The tumor is limited to the uterine body.
Stage 1A Uterine cavity measures 8 cm or less.
Stage 1B Uterine cavity measures greater than 8 cm.
Stage 2 Tumor extends to the uterine cervix.
Stage 3 Tumor has spread to the adjacent pelvic structures.
Stage 4 Bulky pelvic disease or distant spread.
Stage 4A The tumor invades the mucosa of the bladder or rectum.
Stage 4B Distant metastasis is present.

Also American Cancer Society discusses staging in more general terms here: http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_How_is_endometrial_cancer_staged.asp?sitearea=
_________________
Diagnosed Sept. 2005
Stage III-C Endometrial Adenocarcinoma
Grade 2

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