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Where do recurrences come from in early stage CA?

Double Whammy's picture
Double Whammy
Posts: 2835
Joined: Jun 2010

I never really thought about this until recently when my little mind wandered into that dark place. There have been several women here who have had recurrences when their initial dx was early stage, low grade cancer. Helen's was "only" hyperplasia!

My gyn onc explained that the reason I have the smears is to check for recurrence, and that it typically happens in the vaginal vault in the first couple of years, but I never asked how it would get there (or elsewhere). Of course, how did I get it at all in the first place? There's no answer to that, as Maggie says, just a crap shoot.

Inquiring minds . . .


PS, I'm not borrowing trouble or overly concered. This is rather a curious/educational question.

Tresia23's picture
Posts: 77
Joined: Dec 2010

Is it something to do with mitotic rate (speed of cell division), and number of atypical cells that may be lurking following surgery?

Cindy Bear
Posts: 570
Joined: Jul 2009

That's a very good question and I'm sure lots will be chiming in soon with their thoughts. I read a post not too long ago, someone was wondering the same thing, they had a recurrence of cancer (not uterine/gyn. ) but were wondering how that could be when it was supposedly caught very early stages.. there's probably more than one answer since there are so many different types of cancer and everyone's metabolism is different. But the answer given was there's always a chance for recurrence even with early stage cancer.. even with clean margins a chance that microscopic cells lurking somewhere else will make themselves known eventually. Sometimes people develop a secondary cancer, not a recurrence though it might be assumed to be one at first. Thirdly, and this is my own humble opinion, is it possible that the person with recurrence was not staged correctly to begin with. I've seen several women comment on this board that in retrospect, they think they were a stage 3 or 4 to begin with...

Rewriter's picture
Posts: 497
Joined: Dec 2009

I particularly agree with the idea that staging can be incorrect. This, too, is just my very humble opinion. Staging completed prior to 2005, for example, might not include all of the steps involved in 2011 cancer staging. For example, hysterectomies for USPC did not routinely include "complete surgical staging." This involves, in addition to removal of those organs typically taken during such surgery, excision of more than 20 lymph nodes, biopsies of the omentum, and testing of pelvic washings. If our surgeries include these steps, we can be more confident that our staging is "correct"--although FIGO staging recently changed yet again.

This underscores the need to have surgery performed by a gynecologic oncologist who has years of experience doing these surgeries and who seems very up-to-date with research on our particular cancer.

When I first started reading about UPSC, I was completely freaked out. But much of the material I was reading was written prior to 2005, the year that the results of a Yale study were released showing that the six rounds of carbo/taxol protocol cut recurrence by a substantial percentage. When the protocol was implemented, the older literature was much less relevant, and the chance for a cure became a reality.

There is also the possibility of different readings by multiple pathologists. My slides were read three times, with one out of three pathologists not "seeing" the UPSC component of my tumor (polyp). I was lucky that my gyne-onc wanted to pursue an accurate diagnosis.

Last, there is the crap shoot factor. But keep in mind that we still cross streets despite the fact that we "could" be hit by a bus. Life is full of crap shoots; it can also be full of hope and remarkably good luck.

lindaprocopio's picture
Posts: 2022
Joined: Oct 2008

I had 24 lymph nodes removed and biopsied during my original debulking surgery. Only 1 of those showed microscopic traces of cancer cells, enough to make me Stage 3-c. But I often think, what if they'd only taken 20 lymph nodes and not taken the 1 they did with the microscopic cancer in it? After all, the surgeon DID say to my family after my surgery that all of my organs and lymph nodes looked good and he thought we'd caught it very early. I could so easily have been incorrectly staged, except for the extensive lymph node dissection, and even taking 24 lymph nodes, they still left behind dozens more.

And I also know that some cancers exfoliate stray cells just like your skin exfoliates. That's how my cancer was discovered: a stray UPSC cell exfoliated and drifted down to my cervix at the time of my routine annual PAP test. I had no cancer involvement in my cervix, but a UPSC cell was down there anyway. It was lucky for me, as I was totally without symptoms. But it does show how a stray cancer cell could drift off and lay somewhere waiting to make mischief later. Hate to think about that stuff, though.

I am also of the 'crap shoot' theory. Luck of the draw, as much as I would LOVE (& NEED!) to believe that I could eat or not eat certain foods or supplements that would make any difference in how the cards play out. If I can't guarantee a winning hand, I at least know I can enjoy the game, and be a good sport, winning or losing with equal grace.

Ro10's picture
Posts: 1579
Joined: Jan 2009

My PAP test was highly suspicious of "adenocarcinoma". I had no symptoms prior to my diagnosis. The doctors, too felt they had caught the cancer early. It was a shock that it was UPSC. I had 21 lymph nodes removed and 5 were positive. Also the peritoneal washings were positive. The cancer was less than 50% into the uterus. I was diagnosed with Stage III-C.

I felt I have eaten healthy and exercised regularly and other than high cholesterol felt I was very healthy. I too wonder if the stray cancer cell had not shown up on my PAP......what would have happened??????? Would those cells have been there a month before or a month after?????

Don't have any answers to these questions. But taking each day as it comes and making the most of each day. In peace and caring.

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