Uterine (Endometrial) Cancer: My Timeline, My Impending Surgery

Just before midnight on December 12, 2013, I am preparing for my da Vinci robotic radical hysterectomy tomorrow . . . only hours away now after waiting for more than five weeks after getting my diagnosis of uterine (endometrial) cancer (adenocarcinoma). It will be good to be on the other side of this problem. I thought it might be therapeutic for me to recap my timeline, so here goes. This will probably be rather dull reading, but it’s possible some people going through the same journey will find at least some of it instructive.

Highlighted/underscored terms are links to external sources of information. Note that these stories and resources on this site are intended to supplement, not replace, the advice of your clinicians.

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See Uterine (Endometrial) Cancer – My Story & More and Radiation Therapy for Uterine Cancer – My Story & More for a list of all posts to the present, including My Uterine (Endometrial) Cancer Story: Three Peach Roses on My Three-Year Anniversary and Quick Update – My Uterine (Endometrial) Cancer Story: Three Peach Roses on My Three-Year Anniversary. 

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Also note that this post will be updated soon with information about genetic testing for Lynch syndrome, which is often genetically related to uterine cancer, and about treating bladder prolapse (cystocele) after vaginal radiation (brachytherapy). 

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September 1, 2013 (approximately): I started having vaginal discharge/bleeding, not heavy. I’ve had this in the past along with a tendency to develop cervical and uterine polyps, so I was annoyed rather than worried—this was a mistake.

October 15, 2013: I finally had an overdue pelvic ultrasound, which I was supposed to have had some months before. This showed a very thickened endometrial lining and a polyp. My gynecologist said I should have a dilatation and curettage (D&C) within the next couple of months and didn’t seem to think it was urgent; however, later that day, his office called and said he had decided not to wait (good thing).

October 21, 2013: I had my pre-D&C EKG and blood work done by my family doctor. While I was there, I showed her a pink spot on my scalp, and she said I should see a dermatologist because it might be a pre-cancerous lesion.

October 24, 2013: I saw my gynecologist for a pre-D&C exam, but it was a month too early for my Pap test (per the insurance company). So he said he’d do that six weeks post-D&C.

October 28, 2013: I had my D&C, which seemed to be uneventful. Except that I had rather heavy bleeding afterward, unlike following my previous D&C in 2007.

November 4, 2013: My gynecologist called to say, “We’re not done with you yet.” Then he said I had uterine (endometrial) cancer (adenocarcinoma), which surprised us both. The polyp he removed was benign, but there was another mass—see below for the clinical pathology results. He asked me to come into the office that afternoon so he could review my treatment plan under the care of a gynecologic oncologist (GO) to whom he would refer me. He said this was a common gynecologic cancer and that I’d be fine. (In fact, uterine cancer is the most common gynecologic cancer and the fourth most common cancer among women.)

November 7, 2013: I met with the GO, who examined me (I was still sore from the D&C) to see whether he could visualize any cancer in the cervix; he couldn’’t. After reading the pathology report, he called my gynecologist while I was in the office to discuss the results (see below), which were somewhat equivocal about whether the cancer had metastasized into the cervix. They both agreed that my gynecologist had probably brought down the uterine cancer cells during the D&C and that the cancer hadn’t spread to the cervix. To be sure, and to determine my treatment plan, the GO ordered a pelvic and abdominal MRI, as well as a CA-125 (cancer antigen 125) blood test to see whether I had any biomarkers for metastasis. Depending on what the studies showed, I would either be a candidate for primary surgery—a radical hysterectomy if there was no evidence of spread—or I would need pre-operative radiation followed by a radical hysterectomy if there was. He echoed what my gynecologist had said—that this was a common gynecologic cancer and that I’d be fine.

November 8, 2013: I had the CA-125, which showed no evidence of cancer elsewhere in my body.

November 12, 2013: I had the two MRIs, which were a bit grueling, as I described in an earlier post.

November 13, 2013: I saw the GO again, who said the report from the pelvic study confirmed the malignant mass in my uterus, but showed no obvious mass in the cervix. However, it did note cells in the cervix, but he still believed these were pulled down during the D&C. There was no mass in the abdomen. I asked him about having my overdue colonoscopy because my father had had colon cancer, and he said yes, do it first before the hysterectomy so he would know what he was dealing with. I was also due for my annual mammogram and had that spot on my scalp; he said he might be able to arrange for the scalp lesion to be removed after my hysterectomy, but that I should get it biopsied first. All this needed to be attended to before the surgery. He scheduled the surgery for Friday the 13th, a month hence: da Vinci total (radical) hysterectomy (uterus), bilateral salpingo-oophorectomy (fallopian tubes and ovaries), and pelvic and para-aortic lymph node dissection, with a possible abdominal procedure and cystoscopy if necessary. The need for post-op radiation will depend on the final pathology report.

November 19, 2013: I had three medical appoints that day. First, I met with the gastroenterologist, who scheduled my colonoscopy and upper endoscopy, or esophagogastroduodenoscopy (EGD), for December 11—two days before my surgery. This was the earliest appointment he had, and I was lucky to get in to see him as quickly as I did. Next, I had my mammogram, which—thankfully—was normal. Finally, I saw the dermatologist, who biopsied the scalp lesion.

November 21, 2013: The dermatologist called to say the pathology report showed a basal cell carcinoma, the most common form of skin cancer, and referred me to a dermatologic surgeon to have Mohs micrographic surgery. The lesion does not lend itself to total excision in the operating room because of the location, as described in an earlier post. I called the other doctor and scheduled the procedure for December 30, 2013. (See Skin Cancer – My Story & More for details of my surgery and follow-up care.)

November 25, 2013: I had my pre-op chest x-ray and then saw my family doctor for my pre-op exam and bloodwork.

November 26, 2013: My family doctor called to tell me that my bloodwork was fine, and that in fact my cholesterol level had dropped to normal after just four weeks on Lipitor, as described in an earlier post. The urinalysis showed a trace of blood—not surprisingly. And the chest x-ray was “fine.”

December 3, 2013: My GO’s office called to tell me that the pre-op chest x-ray suggested that I had chronic obstructive pulmonary disease (COPD) and that I should see an internist if I developed any symptoms. I called my family doctor, but she reassured me that because I have no symptoms and the report showed no acute problems, the film was probably “over-read”—after all, they do tell you to take a deep breath and hold it while they shoot the film, accounting for the “hyperinflated lungs”(!). Still, it gave me pause because my father died of COPD.

December 11, 2013: I had my colonoscopy and EGD. Because I had both together, they gave me extra anesthesia, which was in the form of so-called conscious sedation (midazolam [Versed] and fentanyl, a sedative and an analgesic). I’ve had conscious sedation before, including for my D&C, and thought it was great—I was never really aware of anything going on. But because of the time required to do two procedures, I partially woke up during the colonoscopy and remember having pain. The doctor later said that my colon was twisty and that I have diverticulosis, a common condition managed by eating more fiber, but that he saw no evidence of cancer. The upper endoscopy showed a small hiatal hernia and gastritis, which I knew about already because of the gastroesophageal reflux disease (GERD) I’ve had for a number of years. All in all, this was a good report. (Postscript: I received the pathology report of the gastric biopsy on December 17, and it showed a hiatal hernia and gastritis, but no evidence of Helicobacter pyloris—no ulcer or cancer.)

December 12, 2013: I finished writing My Sister’s Story (click to read her story of adoption and reunion) and did my best to get myself organized physically and mentally—not so easy to do.

December 13, 2013: It’s almost time to go to the hospital for the da Vinci procedure. My husband is asleep; I’ll have my chance to sleep in the OR. Now I have to make my final preparations.

I will report back after surgery.

Thanks to so many people who have offered their support and good wishes—I am very grateful.

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CLINICAL PATHOLOGY RESULTS

For the record, the  pathology results from my dilatation and curettage (D&C) on October 28, 2013 were reported as follows:

Specimen 1: Endocervical Curettage, Polyp; Diagnosis: Endometrial Adenocarcinoma, Endometrioid Type, FIGO 2, Nuclear Grade 2; Benign Endocervical Polyp. This portion of the diagnosis was questionable (see below).

Specimen 2: Endometrial Curettage. Diagnosis: Endometrial Adenocarcinoma, Endometrioid Type, FIGO 2, Nuclear Grade 2. This portion of the diagnosis was definite and confirmed by MRI (magnetic resonance imaging; see below).

Although the FIGO (International Federation of Gynecology and Obstetrics) Stage is noted above as 2, as I understand it from my gynecologist and oncologist, the MRI I had on November 12, 2013 confirmed that the cancer cells noted in Specimen 1 most likely did not arise in the cervix, but were pulled down from my uterus during the D&C. This is what both doctors believe happened, and the polyp was benign. What this means is that I have a Type 1, Stage 1, Grade 2 Endometrial Adenocarcinoma (a mass that arises in cells that make and release mucus and other fluids), which is considered common, early stage, and highly treatable.*

I am scheduled for a da Vinci hysterectomy on Friday, December 13, 2013.**

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My only symptom was vaginal discharge and bleeding. See your gynecologist if you notice unusual vaginal discharge, which may start as a watery, blood-streaked flow that gradually contains more blood, or if you experience difficult or painful urination, pain during intercourse, or pain and/or a mass in the pelvic area.

Please read more about uterine cancer risk factors in the November 20, 2013 post.

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*For information about my total robotic hysterectomy and my final diagnosis of Endometrial Adenocarcinoma, Endometrioid Type, Stage 1B,  Grade 3, see Uterine (Endometrial) Cancer: Cancer No More–Lessons & a Final Diagnosis from the Ghost of Christmas Present.

**See Uterine (Endometrial) Cancer – My Story & More and Radiation Therapy for Uterine Cancer – My Story & More for details of my post-surgery progress and follow-up care.