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Dr. Andrew Rynne

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Suggest treatment for tumor cells in parametrium of cervix

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Dr. Indranil Ghosh

Oncologist

Practicing since :2004

Answered : 1465 Questions

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Posted on Mon, 1 Sep 2014 in Cancer
Question: My Mother was operated on 18th July for Cervical Cancer ( Wertheim's Hysterectomy). operation was successful and she is recovering fine. After the surgical Biopsy they declared it as Stage 2b, futher we sent her slides to SRL Ranbaxy for review and there they found the left paramatrium free & right paramatrium with few tumor cells all non reactive so Stage 1b. Now doctors here are saying there is one positive & one negative report so considering that she needs Radiation ( Both external Beam & Internal Beam ) + concurrent chemo apart from recent surgery to avoid the recurrence, I discussed this case with one more doctor & he do not think external beam radiation is indicated nor chemo at this time however brachytherapy to upper vagina could be given if surgeon was not able to remove all the tissue however closefollowup will be needed there is higher incidence of collateral damage with external beam radiation so try to avoid that include kidney damage. Please suggest. I am attaching her Reports.
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Answered by Dr. Indranil Ghosh 3 hours later
Brief Answer:
I feel further treatment is needed

Detailed Answer:
Hi
Thanks for your query.
I have gone through both these reports. It appears that few tumor cells are seen in the parametrium by both the pathologists though their final interpretation is different. Apart from this another risk factor is the tumor size of 5 cm (relatively large). One thing is not mentioned, the extent of stromal invasion - superficial versus deep. Deep is another risk factor.

Hence, considering that she is only 59 and presumably quite fit, further treatment with external RT+ weekly chemo+ brachy seems appropriate. If the disease recurs then it becomes incurable mostly. So better not to take chance. Adverse effects are there, but manageable and kidneys can be spared by modern Radiotherapy techniques.

However, this is my personal opinion seeing the reports. The doctors treating her should be able to guide you select the appropriate option.

Hope I have answered your query. I will be available to answer further followup queries, if any.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Indranil Ghosh 39 hours later
Thanks.... but can you please throw light as to what do this statement means in Ranbaxy report & what impact does this statement makes in totality......... " RIGHT PARAMETRIUM SHOW FEW TUMOR CELLS, HOWEVER NO REACTION IS SEEN AGAINST THESE TUMOR CELLS, THEREBY INTERPRETED AS FLOATER"
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Answered by Dr. Indranil Ghosh 1 hour later
Brief Answer:
floaters are artifacts

Detailed Answer:
It means that basically those tumor cells do not belong there and have been transferred from other parts of the specimen during processing (eg, through the cutting blade).

The SRL pathologist felt that as there no reaction (by the normal cells) around the tumor cells, they may be artifacts rather than actual presence of tumor cells. This is an entirely technical area and I can't comment if it is right or wrong.

That's why I suggested to give more treatment rather than less treatment.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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