Lusafag: Your Treatment Dilemma

Lusafag

I hope you'll forgive me if I recap what you've posted in several messages since it many be easier for others to respond to your questions if they have a better understanding of your situation by reading it in one message.

As I understand it, you and your husband are doctors in Pakistan, but since neither of you have been in private practice, you haven't been able to accumulate the funds needed for private insurance. Therefore, you're dependent upon your country's public health system, where local customs can sometimes take precedence over international medical practices.

You are 57 and were diagnosed in February through TVS, and D&C. You had a total abdominal hysterectomy with ovaries, tubes, cervix removed laparoscopically under not very good circumstances. As a result, you've had problems recovering from your surgery, including the development of an infection which has prevented your surgical incisions from healing. This has caused a delay in any further treatment.

Your pathology report shows that you have Endometroid Adenocarcinoma pathological stage T2bNxMx.

One radiologist has recommended just brachytherapy, taking your pT2b pathology as oncology stage 1 Another radiologist disagreed and recommended EBRT and possibly chemotherapy.

You've asked a different oncologist about getting tested for MMR and the possibility of immunotherapy. You also asked if you should seek another CT/MRI or at least a second opinion on your pre-surgery chest CT-scan that showed there were 6-8 nodules, with the largest being 4.8 mm.

That oncologist replied:

-MSI testing is costly and immunotherapy too

-If you can not afford immunotherapy then there is no need for MSI

-Review of CT scan is your call

-At least give brachytherapy

-Rest depends on primary consultant

 

CMB'S QUESTIONS AND COMMENTS:

If your chest scan showed several nodules, why do your doctors believe that your cancer was limited to the endometrium? When other women here have had nodules that look suspicious, their cancer is almost always staged higher than what yours was. And higher stages are treated with chemotherapy as well as radiation.

If you're able, I recommend seeking another opinion of your pathology report, along with the chest CT-scan, before starting any treatment. I would be very concerned about doing just radiation and not chemotherapy without another opinion.

Immunotherapy can be very expensive in the United States too. So most oncologists will start first with conventional chemotherapy, with Paclitaxel and Carboplatin being the most common first line drugs now used.

MAbound has given you some good advice on radiation and I see that you found the NCCN site for further reference as well. The video link you asked about in another message was posted by No Time for Cancer under "OncLive Peer Exchange videos" at https://csn.cancer.org/node/323502

Please keep in mind that many women have come and gone from this board after their treatment ended or, more sadly, when they passed away from their cancer. So while older posts still have lots of great information, the women who originally posted are often not here to respond to current questions. In most cases you'll get better responses by starting a new forum topic with your question(s).

You're in a very difficult position right now and it doesn't help that you've gotten conflicting information from your doctors. I respect the admirable effort you're making to learn more about your options. We definitely want to support you through this time and are very willing to share our experiences.