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Positive pelvic washing

math
Posts: 1
Joined: Dec 2010

I am a 63 year old woman who had sudden vaginal bleeding after going through menopause over 20 years ago. I had a complete hysterectomy (ovaries, fallopian tubes, cervix) earlier this month for endometrium cancer (adenocarcinoma). The doctor said the pathology report was "good", ie., stage 1, grade 1, myometrial invasion < 1/2, no lymphatic/vascular invasion, cervix and serosa free of tumor, both ovaries free of tumor, sentinel lymph mode negative for carcinoma, 9 right pelvic lymph nodes negative, 16 left pelvic nodes negative. The pelvic washings were positive. The surgeon and the pathologist have said that they think the positive washing came from contamination during the surgery because the uterus was perforated during the procedure. (I had the robotic assisted daVinci procedure.)

At my follow up visit the doctor told me that except for the positive washings I would be only monitored every 6 months for 3 years and then annually after that. However, the follow-up treatment is less clear cut because of the positive washings, even though they think it was because of contamination. The doctor decided to refer me for genetic counseling to assess my family history, etc. My mother had cancer multiple times, including uterine and breast cancer in her 20s and 30s. But I am an only child have little information about other family members since I lost contact with them MANY years ago. So I'm doubtful what the genetic counseling will do to help.

I am interested in hearing from anyone who has had a similar experience of having positive washings in an otherwise "good" report. Megace was one thing the doctor through out as a possibility, but after reading the side effects I am hesitant to take that route. I am about 10 pounds over weight, take medication for high blood pressure, and am on medication for high cholesterol. I am physically active (I walk about 200 miles a month) and generally in good health. I am very conflicted about this and will appreciate hearing from anyone who may have had or know about positive washings in an otherwise positive pathology report.

Lisa 00
Posts: 108
Joined: Jul 2009

Greetings,

I only want to say that you might want to consider getting a second opinion from another gynecologic oncologist. It can be very informative and helpful in your search for information and options.

Becky444's picture
Becky444
Posts: 29
Joined: Jul 2010

Hi Math,

I, too, had positive washings after my hysterectomy. My surgery was Sept 2009 so I am a few months down the road. At the time, I was diagnosed as 3A because of the positive washings. I saw the radiologist for my 9 mth ck & she said if I were diagnosed now, it would be a Stage 1. I was diagnosed with UPSC & had 6 carboplatin/taxol and 5 brachy therapies. UPSC has a high recurrence rate too. Do all you can to prevent recurrence and at least you will have peace of mind. I know there are others on the board with UPSC & positive washings who recurred. They felt the positive washings were from a D&C two weeks before my hysterectomy.

Good luck to you & let me know what you decide.

Becky

Double Whammy's picture
Double Whammy
Posts: 2274
Joined: Jun 2010

I doubt your surgeon's feelings would be hurt if you got a second opinion. It sounds like he knows your uterus was perforated during surgery and is presenting you with the facts and statistics as he knows them, but leaving the decision to you. I don't know what I'd do, but I do think I would like some more information before I decide, i.e., hearing another expert opinion. I'm very naive about the nature of stray cancer cells of any grade, but I would be curious about the following: When a wash is done, is any fluid left behind - and if there are any cells left floating around somewhere that are the result of this contamination, can they "plant" themselves somewhere and grow? Does it really matter how cells got into the wash or that they were there? What's the liklihood that the mechanics of the wash itself didn't scatter the cells to other areas of the abdominal cavity? I know absolutely nothing about any of this, but these questions entered my head when I read your post.

Best of luck in making your decision. Please let us know.

Suzanne

Songflower's picture
Songflower
Posts: 632
Joined: Apr 2009

I had everything negative except serous in the uterus and positive washings. The positive washedings recurred into peritoneal carcinmatosis. I had HIPEC. Personally, I believe that intraperitoneal therapy is a good option if your washings are positive. I would also take some intravenous. You need a second opinnion. I've been through alot this year and wish I had had peritoneal washings treated with intraperitoneal chemo.

Diane

lindaprocopio's picture
lindaprocopio
Posts: 2022
Joined: Oct 2008

So far I haven't had any spread to the peritoneal cavity, but I keep waiting for that shoe to drop in one of these scans. I think the fact that I've been on chemo almost constantly for the last year is probably what has kept that from happening so far. Because of my positive washings, I did do 28 rounds of adjuvent IMRT pelvic radiation and am hoping that staves off problems in that area, although the peritoneal cavity extends above the pelvic radiation area, so who know?

I think IP chemo is well worth exploring; I know that's the route I will go if I have a recurrence in the peritoneum and my body is deemed strong enough to endure the IP treatments. I will have to travel to get IP, though, as my chemo oncologist feels IP is too harsh a treatment unless there is hope of a cure, which he doesn't see for me any more.

Speaking of the pelvic radiation, I did have a tidbit from my gyne-onc to share. We were discussing Avastin and its ability to cause bowel perforation if you have a tumor in the bowel anywhere. He said that Avastin is unlikely to cause bowel perforation if you have no cancer in the bowel area, but that if you have inflammation in your bowels from radiation, that may also make you vulnerable to bowel perforation if you take Avastin. He would hestitate to recommend Avastin for me for that reason. So that's another thing to factor in when you are deciding if adjuvant external beam radiation is right for you.

ratajczaktrudy's picture
ratajczaktrudy
Posts: 7
Joined: May 2013

Hi Becky how are you doing now. I had a robotic total hysterecomy two weeks ago. I had positive pelvic washing which also saids metastatic adenocarcinoma which I think was said because microscopic cancer cells was found outside the uterus. My doctor put me on megace for a year to see if it will stop cancer growthIf he told me I would have a laparoscope procedure to see if there is any tumor growth. My sister thinks I should have radiation to kill the cancer cells. My cancer was in the uterine wall superficially to the myometruim. I am not sure if I want to wait for a year to see if the megace works From what I here it doesn't cure he cancer but slows its growth. I Am only 52 with teenage kidDMSO I would like to be around a while for myself and them. 

ratajczaktrudy's picture
ratajczaktrudy
Posts: 7
Joined: May 2013

Hi everybody I hope somebody replies to my post. I hope a lot of you are still alive. Going into this uterine cancer I more or less was told you take out the uterus and everything including the cervix you chance of cure is pretty good. I have read a lot of stuff talking about cancer mestasticizing to different parts if the body. Everyone tells me you will be fine,but as a nurse I guess I am thinking the worse. I guess I would have feel better if there was no positive pelvic washing, then I read a post from a woman with no positive pelvic wash her uterine cancer had spread. My doctor told me if you get cancer uterine was the best to get. I hope some of you people out there has some good news. Thanks

ratajczaktrudy's picture
ratajczaktrudy
Posts: 7
Joined: May 2013

Hi everybody I hope somebody replies to my post. I hope a lot of you are still alive. Going into this uterine cancer I more or less was told you take out the uterus and everything including the cervix you chance of cure is pretty good. I have read a lot of stuff talking about cancer mestasticizing to different parts if the body. Everyone tells me you will be fine,but as a nurse I guess I am thinking the worse. I guess I would have feel better if there was no positive pelvic washing, then I read a post from a woman with no positive pelvic wash her uterine cancer had spread. My doctor told me if you get cancer uterine was the best to get. I hope some of you people out there has some good news. Thanks

light42day
Posts: 61
Joined: Mar 2012

I was diagnosed with Endo cancer stage 1a grade 2 Jan. 2012 and had the DaVinci surgery Feb. 2012.  It went well but I also ended up with a positive pelvic wash.  My Gyn/Onc is pretty sure that it happened during the D & C/ Hysteroscopy.  She have me a choice to just cont to get my 3 mo check-ups and watch it or do 3 rounds of Chemo.  I chose to do the Chemo and I'm glad I did.  I would always wonder if I should have done it (if I ever have a recurrance). 

HealNow
Posts: 1
Joined: May 2013

my experience so far....I had a total hysterectomy (Laproscopic/DaVinci) in January 2013. Tumor was grade 1/stage 1,  lymph nodes were negative, but there were endometrial cancer cells in my peritoneal wash. My doc suggested to treat it aggressively, but left the option to me. I chose to go aggressive. I am doing 6 rounds carbo/taxol chemo to hopefully destroy all those free floating microscopic cells. I just finished round 4. I thought that doing everything in my power now was better than wondering about what-ifs later.

All the best to all you strong women about there... Keep fighting.

Bluebird Bush
Posts: 28
Joined: May 2011

This is all very interesting information and thank you all for sharing your experiences and ideas on this subject. The pathologist found that both of my tubes were blocked and I wonder if that didn't help contain my cancer to the uterus and hopefully prevent it from spreading more. The only spread they documented was to two lymph nodes. The radiologist said there is a small nodule in one lung that wasn't there a year ago, but the oncologist's physician's assistant said that could be any of many things.

Thank you ladies for sharing so generously here, Geni

Gracegoi's picture
Gracegoi
Posts: 59
Joined: Aug 2011

Geni,

I decided to read it through a bit more slowly and it is informative. I was almost in Beckys shoes. They were going to do a DNC because a needle biopsy was not always reliable to test for cancer. I'm with Suzanne in I know little about the importance of pelvic washings I was unlucky finding information about how pelvic washings effect staging. It wasn't mentioned and I find it confusing you can be stage one with positive washings . I guess that may be what stage one with residual means .

I can see why its a good idea to have pelvic radiation as the minimum.

Good luck with the nodual Geni

Bluebird Bush
Posts: 28
Joined: May 2011

Hi Grace, You say pelvic washings is important - - - - I remember the afternoon after my surgery my oncologist-gynocologist-surgeon came into my room with a man she said was from quality control and told me everything went fine except that after they started working in me they realized one of the instruments was dirty (not her word), that it had been through the autoclave but they saw some dried residual tissue on it so apparently they washed me out with more fluid than usual and threw it away because the washings they sent to the pathologist was not all that much. When cancer cells break loose - like floating around in there, don't some of them possibly attached themselves in there and then start making their own little capillary connections? Is the reason there is a lot of recurrence in the end of the vagina where they sew you up because some cells accidentally get squeezed out through the cervix and then accidentally sewed up into that cut end where they sew it shut? This really is complicated and seems like it is full of ifs ands and buts. Thanks for any enlightenment you might send my way, Geni

Cookiemookie
Posts: 6
Joined: Oct 2011

This is exactly my situation.

Everything was good except for the washings.

My Dr has me on Megestrol. I haven't had any problems with it so far, no weight gain and I will soon find out if it has affected my blood sugar. I also have very difficult to control high blood pressure despite being on 7 different medications for it. This has been well before my cancer diagnosis.

I met with a radiation oncologist a few weeks after my radical hysterectomy in May. He presented me with facts and asked what I felt i wanted to do. It seemed to me at the time that it would be overkill for my situation. He agreed but said it was up to me. I went back to my gyn oncologist a few days after and he didn't seem comfortable not doing anything so he put me on the megestrol. I've had one pelvic exam so far and have a Pap in December. So we'll see what that brings.

I'm still not sure if I did the right thing.

If it wouldn't of been for that cytology report I'd be doing fine. It actually keeps me awake at night wondering if I did the right thing :(

Cookiemookie
Posts: 6
Joined: Oct 2011

This is exactly my situation.

Everything was good except for the washings.

My Dr has me on Megestrol. I haven't had any problems with it so far, no weight gain and I will soon find out if it has affected my blood sugar. I also have very difficult to control high blood pressure despite being on 7 different medications for it. This has been well before my cancer diagnosis.

I met with a radiation oncologist a few weeks after my radical hysterectomy in May. He presented me with facts and asked what I felt i wanted to do. It seemed to me at the time that it would be overkill for my situation. He agreed but said it was up to me. I went back to my gyn oncologist a few days after and he didn't seem comfortable not doing anything so he put me on the megestrol. I've had one pelvic exam so far and have a Pap in December. So we'll see what that brings.

I'm still not sure if I did the right thing.

If it wouldn't of been for that cytology report I'd be doing fine. It actually keeps me awake at night wondering if I did the right thing :(

Bluebird Bush
Posts: 28
Joined: May 2011

I hate that it keeps you awake at night worrying about your decision. Our diagnosis sure does impact our lives. Hope everyone has as good a day as possible - Geni

Gracegoi's picture
Gracegoi
Posts: 59
Joined: Aug 2011

I don't believe I stated that the pelvic washings were important , More that I did not know much about them. I would think they are though.

I'm sorry that happened to you. I'm not sure what to say about that except I'm concerned about what you wrote. I do remember when I read on this board after being diagnoised I read about possible contamination and the wonderings/ fear of cancer spreading through that.

Maybe some other people who know more about washings will chime in or start another thread just about pelvic washings.

You haven't done anything wrong Geni. It is an old post and sometimes people post once and don't return which is odd. Maybe she will return one day. Its the process thats important if this thread spoke to you its important for you.

Cookie if is any consolation, I wondered if I did the right thing . So far I have .

Grace.

norma2's picture
norma2
Posts: 486
Joined: Aug 2009

I see others responding to your post and you haven't acknowledge the response. Just wondering how you are doing since December, 2010. Hope you are doing well. Norma

Bluebird Bush
Posts: 28
Joined: May 2011

Hi Norma - - thank you for this. I didn't even realize what we were doing - - I am just sort of feeling my way around here - don't actually know what I am doing. I don't know much about computers and postings and etc so I pretty much need all the help I can get. Thanks. Have a good day, Geni

ratajczaktrudy's picture
ratajczaktrudy
Posts: 7
Joined: May 2013

To the person who had her surgery over a year ago with the posive washing did the chem work  to get rid of the positive washings. My oncologist said I wouldn't need chemo. But I would néed megace for a year then a laparascopy I am not sure what to do. My sister thinks radiation, but when I read about it it saids it increases risk of colon cancer which my Dad had 20 years ago. Not sure how quickly if the megace does not work and if the cancer spreads to different organs, there is not a lot of information out there and different web sites said different things and cancer has been around for a while so you would think doctors would know how to help people esp telling Pts that if you get cancer uterine is the best one to gdoctors dad cancer was over 20 years ago and he is still alive.

light42day
Posts: 61
Joined: Mar 2012

I'm considered to be free of cancer now after the chemo.  My last pelvic checks and ct scans have been good.  It will be 18 months at my aug. check up.  It's a hard decis ion-whether to have chemo or radiation or not.  You could get a second opinion maybe.  

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