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How long can one have grade 1 uterine cancer before it spreads?

DOCTOR OF THE MONTH - May 2014
May 2014
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Radiologist
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Question
How long can one have grade 1 uterine cancer before it spreads or advances....
Posted Thu, 6 Mar 2014 in Cancer
 
 
Answered by Dr. Vivek Chail 2 hours later
Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXX Thanks for writing in to us. The term uterine cancer may apply to cancer in the uterus involving any particular region like the endometrium, cervix, uterine sarcomas or gestational trophoblastic disease. I suppose you are asking about endometrial cancer. Please correct me if it is wrong. The grade of the cancer refers to the appearance of the cells in the tumor and gives an idea of how aggressive the cancer is. Grade 1 cancers are made up mostly of normal-looking cells; grade 2 cancers have more abnormal-looking cells; and grade 3 cancer cells have a higher percentage of abnormal looking cells. Review of latest literature says and I quote.."Three prognostic groupings of clinical stage I disease become possible by careful operative staging. Patients with grade 1 tumors involving only endometrium and no evidence of intraperitoneal disease (i.e., adnexal spread) have a low risk (<5%) of nodal involvement. Patients with grade 2 or 3 tumors and invasion of less than 50% of the myometrium and no intraperitoneal disease have a 5% to 9% incidence of pelvic node involvement and a 4% incidence of positive para-aortic nodes. Patients with deep muscle invasion and high-grade tumors and/or intraperitoneal disease have a significant risk of nodal spread, 20% to 60% to pelvic nodes and 10% to 30% to para-aortic nodes. One study was directed specifically at stage I, grade 1 carcinomas of favorable histologic type. The authors identified the following four statistically significant adverse prognostic factors: Myometrial invasion. Vascular invasion. Eight or more mitoses per ten high-power fields. An absence of progesterone receptors." I have worked in a cancer institute for three years and in my opinion the duration before disease spread occurs is a difficult question. There are situations where cancer can spread to lymph nodes and surrounding stages even in early stages. Diagnostic workup should ideally be done within a month of cancer detection and staging often guides further treatment. Cancer spread can take months to years and is different in every patient. Once detected in early stages treatment response is the best. Hope I have answered your query. Do write back if you have any doubts. Regards, Dr.Vivek
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Follow-up: How long can one have grade 1 uterine cancer before it spreads? 29 minutes later
Thank you for such a complete answer. I had the biopsy 4 weeks ago and am not scheduled for surgery for 2 more weeks. I have already uploaded the ultrasound report as well as the biopsy. I would appreciate your opinion. I will receive the davinci surgery and the organs will be removed through the vagina in tact. I was told preliminary testing will be done in the or and it will then be decided whether they will remove the lymph nodes or not. I am experiencing a mild cramp like feeling with an occasiona twinge of slight pain. That is why I ask how fast it can travel. I know there are no final words until after the surgery and the final biopsies. I just am concerned about it spreading. Thank you again and I do appreciate any information you can give. ...Diane
 
 
Answered by Dr. Vivek Chail 56 minutes later
Brief Answer: Please upload reports again Detailed Answer: Hi XXXX Thanks for writing back with an update. It is nice to know that you are under good medical treatment and a surgery has been scheduled in two weeks. I am sorry to say that the reports are still not uploaded and not visible to me. May I request you to make a repeat attempt at uploading or send a mail enclosing your reports to YYYY@YYYY I suppose your doctors will take a decision on lymph node removal after removing the uterus and examining it during surgery. Pain in the region can occur due to various reasons, however alarming signs include discharge and bleeding through vagina with associated pain. I am waiting to have a look at your reports but the spread may take at east 6 months to a year to happen. Hope I have answered your query. Do write back if you have any doubts. Regards, Dr.Vivek
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Follow-up: How long can one have grade 1 uterine cancer before it spreads? 27 minutes later
I have just uploaded the ultrasound and the uterine biopsy reports. And yes, I understand that they will examine the uterus while I am in the operating room. Depending on what they see and feel they will or will not remove the lymph nodes. I will have to wait 2 weeks for the final reports but at least will have some idea immediately after surgery when I know if the lymph nodes were removed or not. I am not having any discharge. At least not any bleeding. Like I said mostly just this light ache like a menstrual cramp but then I do not have it all the time. again, thank you for any info you can give. Diane
 
 
Answered by Dr. Vivek Chail 9 hours later
Brief Answer: Please find detailed answer below Detailed Answer: Hi Diane, Thanks for writing back with reports. The ultrasound findings do not mention anything seriously wrong with your uterus and endometrium. The biopsy report however draws attention to cancerous appearance of cells. With these findings, it will take at least 6 months to a year before any spread may occur. Concerning lymph nodes, your surgeon will decide on examining the operated specimen of uterus if you really need nodal clearance. The ache and cramps are insignificant keeping in mind the ultrasound appearance of your uterus. Do get treated for any urinary tract infection should you be having it. Hope I have answered your query. Do write back if you have any doubts. Regards, Dr.Vivek
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Follow-up: How long can one have grade 1 uterine cancer before it spreads? 2 hours later
Thank you for the information and answering my question. Your words have been the most informative and reassuring I have had yet. I have the surgery in less than 2 weeks and am feeling better and better about it. I did not think I could be so lucky to survive two cancers within one year but it looks like maybe I can. I am told to be more concerned about the renal cancer, stage 3a, than anything else. I guess this hysterectomy and related cancer is more of a condition and a bump in the road for me. I have to tell you that when they did my ct scan on the kidney it was originally a stage 2. The date of surgery the surgeon said it was a stage 1 but when the results came back it was a 3a. I asked him how far outside the kidney it had gotten and he said purely microscopic. He was amazed and surprised himself. He took out all surrounding tissues and the adrenal glad and all margins came back negative. So I am feeling positive he got it all and that I will be ok. Now, I ask for your opinion.......I believe those test were uploaded already too if you should want to review them. I would like your opinion on my survival with the kidney cancer. Thank you again for making my day....Diane I have another question.....could this cancer be the cause of my fatigue and feeling weak? I went shopping today and am about done in. I just had all my blood word done a few weeks ago as follow up for my kidney cancer and it all came back fine. I remember feeling tired all the time before I was diagnosed with the kidney cancer. Again, thank you for any information you can give me...
 
 
Answered by Dr. Vivek Chail 10 hours later
Brief Answer: Please find detailed answer below Detailed Answer: Hi Diane, Thanks for writing back with updates. You have put it right in saying that the hysterectomy is just a small bump. The kidney cancer, being stage 3a is more of a concern. I just hope that the entire cancerous kidney was removed and as your surgeon did not find any traces of cancer in the cut margins of surrounding tissues and adrenals. Regarding kidney cancer reports, I will be happy to review those but I cant find that uploaded. Reviewing the reports is important because it will tell the exact features and why the tumor was upgraded from stage 2 on CT scan to stage 3a on surgery. We can continue the discussion further once the reports are made available to me. However, with regular follow up kidney cancer survival is good and I have seen patients surviving decades after surgery. Your fatigue and weakness must be due to the physical and mental stress that you have been through for the last year with two separate conditions. I am not sure if the environmental conditions are harsh enough to cause tiredness in your region. Further after being diagnosed stage 3a kidney cancer, you might have taken various forms of medical treatment after surgery like chemotherapy and radiation. This can also cause a significant physical stress on some of the organs leading to slight alteration in functioning which is often reversible. During cancer treatment, due to medications the immune system may be suppressed and the body is more vulnerable to mild infections like flu which can take longer than usual to treat. With the spirit and zeal that you show, I am sure you will win the fights against cancer. Wishing you good health. Hope I have answered your query. Do write back if you have any doubts. Regards, Dr.Vivek
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Follow-up: How long can one have grade 1 uterine cancer before it spreads? 13 hours later
I have uploaded the report of the ct scan that detected my kidney cancer and also the pathologists report of the biopsies. I am anxious to get your opinion. I did not receive chemo or radiation therapy after the kidney surgery as they felt it was well contained. I was told the amount that had gotten outside of the kidney was microscopic and he felt that he had taken enough surrounding tissue with it that he got it all. I continue to be monitored every 3 months with periodic blood test, chest xrays and occasional ct scans. Thank you again for your time and your information. Diane
 
 
Answered by Dr. Vivek Chail 28 minutes later
Brief Answer: Please find detailed answer below Detailed Answer: Hi Diane, Thanks for writing back with reports. The CT scan report is attached but the biopsy has not been sent, probably in error. The CT scan report clearly shows two separate lesions in the left kidney and these do not appear to be connected. As a conclusion, it has been mentioned as angiomyolipomas or kidney cancer. Angiomyolipomas are non cancerous but cannot be differentiated from a cancer on imaging except when dealing with a tumor of higher stage which has spread beyond the kidney. It is worth mentioning that there is no vascular invasion or any loss of fat planes around the left kidney. A continuous monitoring every 3 months along with blood tests, X rays and occasional CT scans is a good method of surveillance. Even the slightest doubt regarding recurrent tumor will be monitored carefully. Hope I have answered your query. Do write back if you have any doubts. Please re send the biopsy report if you wish to have it reviewed by me. Regards, Dr.Vivek
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Follow-up: How long can one have grade 1 uterine cancer before it spreads? 30 minutes later
I am so sorry.... I sent you two copies of the ct scan report. I just uploaded the biopsy report. Again, I appreciate your opinions..thank you so much for your time.explain what "malignant neoplasm corpus uteri except isthmus" Means?
 
 
Answered by Dr. Vivek Chail 12 hours later
Brief Answer: Please find detailed answer below Detailed Answer: Hi Diane, Thanks for writing back with reports. I am sorry to say that your endometrial biopsy report still remains unavailable to me. Please contact the customer service for any help that you may need. The terminology "malignant neoplasm corpus uteri except isthmus" refers to the international classification of disease guidelines describing disease details. In simple language it means cancer of the uterus body. Please re send the endometrial biopsy report. Regards, Dr.Vivek
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Follow-up: How long can one have grade 1 uterine cancer before it spreads? 10 hours later
I don't know why my computer wont sent the biopsy report though this chain. I have emailed it to you via email to YYYY@YYYY to you attention. I am hoping you can now review our past conversations about my kidney cancer and give me any information, prognosis or opinions. Thank you again for your time...Diane
 
 
Answered by Dr. Vivek Chail 15 hours later
Brief Answer: Please find detailed answer below Detailed Answer: Hi Diane, Thanks for writing mailing your report. The diagnosis made is clear cell conventional renal cell carcinoma in your left kidney. It may be noted that there is involvement of the kidney capsule and microscopic spread to the fat around the region (adipose tissue). The left renal artery and vein remain uninvolved. These show that the tumor was still locally active at the time of removal but did not show any aggressive feature that needed chemotherapy or radiation. Therefore I think your doctors are doing right by keeping you on regular follow up and your kidney cancer remains almost completely curable. Please have a strong will power to fight your endometrial cancer and you can lead a normal life. Wishing you good health. Hope I have answered your query. Do write back if you have any doubts. Regards, Dr.Vivek
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