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Choices

14 Jun 2018 10:54

Well here it is......

Background

13/04 - Diagnosed endometrial cancer - stage 1b grade 1

14/05 - radical hysterectomy - keyhole

19/05 readmitted to hospital with infected incision - given IV antibiotics then two courses of oral antibiotics then antibiotic cream - wound getting better but still infected

27/05 histology upgraded cancer from grade 1 to 3 but still stage 1b - not seen by my own consultant

27/05 given choice of further surgery to test lymph nodes  or five weeks radical radiotherapy. 20% chance lymph nodes positive for cancer cells.

12/06 saw my own consultant for further discussion- still no decision.

Choices are:

1. Further keyhole surgery to remove lymph nodes. If test positive for cancer then five weeks radical external radiotherapy or if negative two or three sessions of internal radiotherapy.( less invasive and fewer side effects)

2, Go straight for five weeks radical radiotherapy.

I've gone over it time and time, a rock and a hard place. Taking into consideration problems with surgery. Also I am type 1 diabetic so skin is very sensitive and infects more easily, so external radiotherapy could cause problems.

Now what would you do? I know the final decision must be mine but any objective input would be much appreciated,

 

 

Choices

14 Jun 2018 12:11 in response to Sundial

Hi Sundial.

Given your choices I would go for the keyhole surgery first to remove the lymph nodes.  

The reason I would make this choice is that your cancer is staged as T1b. That's stage 1, not even stage 2.  The grade 3 is an additional worry but your cancer is still early stage with no evidence that it has begun to spread.  It has clearly been caught early.

If you go for the radical radiotherapy without the surgery, then there is a good possibility that you'll receive unnecessary treatment, and run all the risks of side-effects with no clinical benefit. 

If the removed nodes show evidence of spread then you need to have radical radiotherapy - but at least you'll know that you really need the therapy.  

And if the removed nodes show no evidence of spread then you can be reassured (as much as clinically possible) that there's no evidence of spread and you'll be spared the intensive therapy.

Of course, there are no guarantees in medicine, and all tests have a false positive and false negative rate.  There is an assumption in my logic that the false negative rate is sufficiently low that you're prepared to take the risk that your cancer might have spread already and yet left the nodes unaffected. If that small risk leaves you in a cold sweat then go for the radical radiotherapy option - but if you can live with it then consider the lymph node surgery option. 

I hope other forum member will venture their opinions so you get many viewpoints. 

Choices

14 Jun 2018 12:28 in response to telemando

Thank you for your reply. Of course there are also risks associated with lymph removal to consider.

I hope others will offer their viewpoints also. I know it’s my choice but I think finding out  whst others think objectively is a good thing.

Sundial