Endometrial Cancer dx - Lung nodules CT Scan
Hello all...I'm new to the board, just joined. I was dx with endometrial cancer on November 1, 2017. Had a full hys, including the removal of both ovaries and tubes on December 8th, 2017. I am now in surgical menopause at the great age of 40!! 
There was no prior history to gyno cancers in my family history. So it came as a shocker. I am still recovering from the surgery and get tired often. I have always been in shape, cross fit, weight training and good BMI. Unfortunately, since this dx, I feel my whole body has changed in a matter of weeks! I was told that my CT Scan showed two - 3mm nodules one in the lower left lung lobe and another in the middle upper right lobe. Along with a shadowing in the center of my chest. I get shortness of breath and have a constant cough. My oncologist/gyno want to repeat the scan this March, as it will make 3 months. Can it be possible...that my cancer has metastasis? I was dx with Stage 1A. Grade 1 with lymphovascular invasion, limited to the uterus. The current course of treatments are just observation , attending all my 3 month check ups. Thoughts?
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Sorry you had to find us, but
Sorry you had to find us, but glad you did. There will be a lot of ladies to add their input to you. My opinion is to get all your reports and get a second opinion from a different cancer dr. Have you received your pathology report from the hys? Did the dr state you should have chemo or radiation? If the CT is showing things that should not be there, waiting is not an option. You have to be your own advocate. My opinion only. Good Luck trish
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lymphovascular invasion
Those are the troubling words in my mind. Lymphovascular invasion is the same thing as lymphovascular space invasion and is defined as the spread of a cancer to the blood vessels and/or lymph system. It's a pathway to metastasis and I'm surprised you weren't treated with at least chemo with that finding. Endometrial cancer has a preference for metastasizing to the lungs and that CT scan and your other symptoms are very concerning. You need a 2nd opinion pronto. This does not sound like a watch and wait situation.
You may want to read this:
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They too found a 2mm
They too found a 2mm pulmonary nodule in my right middle lobe, a 4 mm pulmonary nodule in my right lower lobe, and a 2 mm pulmonary nodule in my left upper lung during my initial CT scan in May 2016. Last year, I seen a lung oncologist. He is not worried about them, as these sizes are common as scar tissue, allergies, etc. I think they have to arrive at a larger size, before they consider them cancer.
I am undergoing another CT in the next few weeks to see if they have grown any. It has been six months since my last scan. Google lung nodules and you will see they are quite common.
But, again, like all the other women have encouraged you to do – be your own advocate. I didn’t take my radiologist’s word or oncologists word. I wanted to hear from a lung oncologist that these were nothing to be concerned with and get established with one early on, just in case they do develop into cancer. So, I begged and pleaded for them to give me a referral to one. He (lung oncologist) thinks I’m being over the top and the scans are going to do my body more harm than good. Oh well, I have learned the hard way to be your own advocate. I see him in a few weeks, to go over the results. I’ll just take him a nice box of chocolates and tell him how much I appreciate him taking great care of me and being understanding of my concerns. You definitely want a GREAT treatment team. I’m your proactive type of girl vs. reactive. Lol!
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LVSIMAbound said:lymphovascular invasion
Those are the troubling words in my mind. Lymphovascular invasion is the same thing as lymphovascular space invasion and is defined as the spread of a cancer to the blood vessels and/or lymph system. It's a pathway to metastasis and I'm surprised you weren't treated with at least chemo with that finding. Endometrial cancer has a preference for metastasizing to the lungs and that CT scan and your other symptoms are very concerning. You need a 2nd opinion pronto. This does not sound like a watch and wait situation.
You may want to read this:
Thank you for the link. I did read that extact link when I got the dx of LVSI and it is disheartening to read that the both recurrence and overall survival is not good in low grade Endometrial cancer. I'm contemplating a second opinion.
Again thank you.
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The only way you are going tocalliegirl said:My path report
All, thank you for prompt responses and support means a great deal !!! November 1st, as we all know well my life too changed hearing the words cancer.
My pathology report states Figo Grade 1, with 33% myometrial invasion and angiolymphatic invasion. Greatest dimension of my tumor was 2cm. Histologic type endometrioid adenocarcinoma. States Lymph-Vascular Invasion: present. Cancer was not found elswhere other than within the lumens of my fallopian tubes. Stated: detached fragments of endometrial carcinoma within the lumens only. Tumor was limited endometrium/or/invades less than 1/2 of the myometrium. My results also showed a mismatch of repair protein expression, and it has been suggested I get screened for Lynch syndrome.
I know that I never had nodules before on my lungs, and also a shadowing in the center, radiologist stated an abnormal lung field findings. My gyno/oncologist said he is not too concerned but wants to compare the results when I go for my 2nd scan in March. I am confused about the whole LVSI. If is present then why not provide treatment? When I asked this question I was told because my cancer was low grade and that "they believed" LVSI was only present within the uterus. I just find this hard to believe and knowing about these nodules....is it possible I'm over-reacting??? Can one go from stage 1 to stage 4 that fast?
The only way you are going to put your mind at ease, is to get a second opinion. Again, I don't think the nodules are something to be concerned with, due to their size, at this time. My report states Indefinite (none seen, but can't rule out, as early cells cannont be seen) for Lymphovascular Invasion, 5.5 Tumor Size, and .3 mm depth of invasion in myometrial wall, Stage 1a NO, FIGO (Grade) 3. Again, get a second opinion from an expert in this field - it can't hurt to expand your treatment team.
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I was diagnosed UPSC Stage1acalliegirl said:My path report
All, thank you for prompt responses and support means a great deal !!! November 1st, as we all know well my life too changed hearing the words cancer.
My pathology report states Figo Grade 1, with 33% myometrial invasion and angiolymphatic invasion. Greatest dimension of my tumor was 2cm. Histologic type endometrioid adenocarcinoma. States Lymph-Vascular Invasion: present. Cancer was not found elswhere other than within the lumens of my fallopian tubes. Stated: detached fragments of endometrial carcinoma within the lumens only. Tumor was limited endometrium/or/invades less than 1/2 of the myometrium. My results also showed a mismatch of repair protein expression, and it has been suggested I get screened for Lynch syndrome.
I know that I never had nodules before on my lungs, and also a shadowing in the center, radiologist stated an abnormal lung field findings. My gyno/oncologist said he is not too concerned but wants to compare the results when I go for my 2nd scan in March. I am confused about the whole LVSI. If is present then why not provide treatment? When I asked this question I was told because my cancer was low grade and that "they believed" LVSI was only present within the uterus. I just find this hard to believe and knowing about these nodules....is it possible I'm over-reacting??? Can one go from stage 1 to stage 4 that fast?
I was diagnosed UPSC Stage1a less than 1/2 myometrium invasion with extensive LVSI. The doctors advised chemo 6 rounds and 3 brachytherapy treatments based mostly on the LVSI. I would certainly look further into why they haven’t suggested that. Anything more than three blood vessels affected is considered extensive. They might treat a lesser degree differently.
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My path report
All, thank you for prompt responses and support means a great deal !!! November 1st, as we all know well my life too changed hearing the words cancer.
My pathology report states Figo Grade 1, with 33% myometrial invasion and angiolymphatic invasion. Greatest dimension of my tumor was 2cm. Histologic type endometrioid adenocarcinoma. States Lymph-Vascular Invasion: present. Cancer was not found elswhere other than within the lumens of my fallopian tubes. Stated: detached fragments of endometrial carcinoma within the lumens only. Tumor was limited endometrium/or/invades less than 1/2 of the myometrium. My results also showed a mismatch of repair protein expression, and it has been suggested I get screened for Lynch syndrome.
I know that I never had nodules before on my lungs, and also a shadowing in the center, radiologist stated an abnormal lung field findings. My gyno/oncologist said he is not too concerned but wants to compare the results when I go for my 2nd scan in March. I am confused about the whole LVSI. If is present then why not provide treatment? When I asked this question I was told because my cancer was low grade and that "they believed" LVSI was only present within the uterus. I just find this hard to believe and knowing about these nodules....is it possible I'm over-reacting??? Can one go from stage 1 to stage 4 that fast?
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thank you so much for yourWannabeatit said:I was diagnosed UPSC Stage1a
I was diagnosed UPSC Stage1a less than 1/2 myometrium invasion with extensive LVSI. The doctors advised chemo 6 rounds and 3 brachytherapy treatments based mostly on the LVSI. I would certainly look further into why they haven’t suggested that. Anything more than three blood vessels affected is considered extensive. They might treat a lesser degree differently.
thank you so much for your response....i hope you are doing a lot better...and stronger...
it is strange really...because he told me I was intermediate risk level with the kind of LVSI I had, and the only reason why they elected no further treatments because of my age 40, I am in good health prior to the dx of this cancer, and that the LVSI was supposedly only contained within the uterus...yet, I find this hard to believe because my thoughts are once it is in LVSI system it can go anywhere...and now my lungs have 2 nodules and unspecific shadowing within the lung field. ugh sigh..
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I hope you can get answers ascalliegirl said:thank you so much for your
thank you so much for your response....i hope you are doing a lot better...and stronger...
it is strange really...because he told me I was intermediate risk level with the kind of LVSI I had, and the only reason why they elected no further treatments because of my age 40, I am in good health prior to the dx of this cancer, and that the LVSI was supposedly only contained within the uterus...yet, I find this hard to believe because my thoughts are once it is in LVSI system it can go anywhere...and now my lungs have 2 nodules and unspecific shadowing within the lung field. ugh sigh..
I hope you can get answers as quickly as possible. I think you need to push your doctor a little harder. Please keep us posted.
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Second Opinion
I share your diagnosis of endometrioid adenocarcinoma; Stage IC, Grade 2. I believe my cancer had penetrated more than 50% through the uterine wall but all the other organs and lymph nodes removed were clear. Nevertheless, in 2005, my surgery was followed by external pelvic radiation. Brachytherapy was planned but later scrapped bc the doctors regarded me as cured and felt that the damage of brachytherapy was not warranted for my age (51). Five years later, I had a recurrence to a para-aortic lymph node and the CT scan also showed a suspicious lymph node above my clavicle and scattered lesions were seen in my lungs. At that point, doctors indicated that the radiation to the para-aortic node was "pallliative" (I was in pain because the tumor was pressed against a nerve in my sacral spine area) to make me more comfortable but not to cure me. The indication was that I could expect to live perhaps 12 months. I was started on high dose progesterone and, happily, I lasted another five years with no evidence of disease until my second recurrence in November 2016 when four small nodules were detected in my lungs. They were too small to biopsy and I elected to go with immediate treatment rather than wait 3 months for a re-scan to see if they grew. I went through 12 rounds of chemo in 2017 and am now, again, classified as "no evidence of disease."
Based on my personal experience, an early stage, low grade cancer is no guarantee of "cure." I don't understand your treatment limited to surgery when cancer cells were found outside your uterus in a lymph node. Once the cancer gets into the lymph-vascular space, it can go anywhere. Certainly, lung nodules might have an innocent explanation but in conjunction with a cancer diagnosis, it raises serious questions.
Looking back, I wish I'd had the opportunity to have my lung nodules biopsied but waiting for additional growth is hard. You're 6-8 weeks away from a re-scan and you don't yet have a second opinion provider lined up so maybe the wait is worth it. But I join with the others in urging you to get a second opinion. Hopefully, you llive in an area where there are several gynecological oncology practices to choose from. Please investigate your options and choose the one with the best academic credentials and patient recommendations. And if you are able to get a biopsy, please consider doing that. Or, perhaps surgical removal will be possible.
But I would not be complacent. The appearance of suspicious nodules so soon after your first diagnosis would concern me. I'd not be so quick to accept the doctor's certainty that it's nothing. It's too small to diagnose reliably now, so how does he know. Good luck to you and best wishes, Oldbeauty
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I would be concerned, but not
I would be concerned, but not worried .... yet.
Did you have a CT scan before that did NOT show any lung nodules? There are such things as benign lung nodules ... actually, they're pretty common. Here is an article that shows what I mean:
https://www.verywell.com/lung-nodules-symptoms-causes-and-diagnosis-2249304
As the article indicated (and I found out re a few friends' experiences), CT scans "can find find lesions ... but don't give a measure of what is happening in a nodule."
However, that being written, I would be concerned about an infection or inflammation at the very least; particularly with that shadow. There is all sort of ... stuff ... going around lately. Also, I doubt you're going to be too relaxed for three months knowing there is a chance ... perhaps not a high one, but a chance nonetheless ... that there may be cancer. A second test or second opinion might be good for your peace of mind. At the very least, perhaps the second doctor can explain WHY a watch and wait approach is best.0 -
I agree with Mrs. Berry
I got my pathology report and had the same grade adenocarinoma you have but it states no invasion to the lymph system. So you should see somebody else. I don't like the sound of it.
As far as the lungs go, I was told years ago I had an atypical lesion on my right lung. Upset me badly. Had it re-evaluated and it turns out it's a scar from pnemonia. But check it out with somebody else. I don't like it when doctors don't answer specific questions and blow you off!
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Saltycandy13 - Good News!saltycandy13 said:I agree with Mrs. Berry
I got my pathology report and had the same grade adenocarinoma you have but it states no invasion to the lymph system. So you should see somebody else. I don't like the sound of it.
As far as the lungs go, I was told years ago I had an atypical lesion on my right lung. Upset me badly. Had it re-evaluated and it turns out it's a scar from pnemonia. But check it out with somebody else. I don't like it when doctors don't answer specific questions and blow you off!
Congratulations on the good pathology report! That is awesome.
Earlier this month I took my Dad to the pulmonologist (he has emphysema and fibrosis). There were some bright white specks on his scan and the doctor asked him ‘Have you been around chickens?’ Dad grew up on a farm and in his early 20s lived in a rooming house that was converted from a chicken coop. Apparently there is a virus that is non-threatening but manifests itself as small scar tissue in the lungs. I could see them, small bright dots. The rationale For this story is to show that probably only a pulmonologist would recognize this type of nuance in a scan.
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It's not just the nodes & shadow
It's the nodes and shadow in combination with your symptoms of shortness of breath, chronic coughing, and fatigue that make this worrisome even though there are other possibilities as others have suggested. Have you had any fever since surgery that this could be a lung infection? If you had your surgery back in November and haven't had other treatment since then, you should be feeling more like your normal self by now. You're probably getting tired of us saying get a second opinion, but I really think living with the worry about what's going on has got to be worse.
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Thank you!
for all your responses, advice, support and concern...Yes, I am thinking strongly about getting a second opinion. I truly do not feel comfortable with the path report and my oncologist telling me that LVSI was present
and yes the nodules are way too small to biopsy...i was thinking to get the CT Scan done in March, compare it to Dec 2017 images, and if there are changes see a lung specialist...
it's all so strange...because I try my very very best not to get paranoid or worried with a new pain or discomfort, especially in my pelvic area...but there are some days it's too difficult not too...
Again many thanks ...hugs and strength to you all Cheers! XO
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thank you, I hope you areMoeKay said:LVSI
I was diagnosed with stage 1C, grade 2, endometrial adenocarcinoma in 1999, and one of the risk factors I had for recurrence was extensive LVSI. I had several other risk factors which you don't appear to have such as outer-third myometrial tumor invasion, lower uterine segment involvement and a fairly large tumor, approximating 4 cm. I was treated at that time with both internal and external radiation. Chemotherapy was not standard of care in 1999 for early stage endometrial adenocarcinoma.
If I were you, I would not only get a second gyn-onc opinion on your treatment plan, I would get a second opinion on your pathology by a gyn-pathologist. For example, I'm puzzled by the finding regarding your fallopian tubes. Has someone explained to you the meaning and significance of the statement: "Cancer was not found elswhere other than within the lumens of my fallopian tubes. Stated: detached fragments of endometrial carcinoma within the lumens only"? After my diagnosis I called the pathologist directly to speak to him about findings on my pathology report. You might want to touch base with the pathologist who wrote your report as a starting point. Also, do you know whether your LVSI was extensive or more limited? If it was not extensive, perhaps that may have also factored into your doctor's no chemotherapy or radiation recommendation (in addition to your young age), but only he can answer that question for you.
If I were you, I would also see a pulmonologist. You have more than just a few tiny nodules, which may or may not be of any significance. You also have a "shadowing in the center of your chest," as well as a constant cough, shortness of breath, and tiredness. Given these factors, I believe a consult with a pulmonologist is in order. In 2009, I went to the ER for a chronic cough. I had troubling findings on a chest CT. I was misdiagnosed in the ER, and it took me several months to get a correct diagnosis, but eventually I was diagnosed with and treated for eosinophilic pneumonia. Along the way, I was told that there was a suspicion of metastatic cancer based on the CT findings, which eventually was determined not to be the case. But while I did not have metastatic cancer to the lung, I had a very serious medical condition that required a lengthy course of treatment.
Good luck with getting answers to all your questions. I wish you the best of health.
thank you, I hope you are doing well ...appreciate all the advice...
my oncologist told me I am at intermediate risk for recurrence, but given my age 40 and the low grade tumor and stage , it was decided by a panel of doctors , some weekly tumor board conference (i have the report) to only keep an observation...
the whole LVSI thing is what confuses me the most, because in my pathology report it does not stipulated how extensive it is...only that it was present.
it states that the tumor limited to endometrium or invades less than 1/2 of the myometrium that regional lymph nodes cannot be assessed and lymphovascular invasion - present.
im waiting on my next CT scan (lungs) in mid march, then my 3 month follow up with my oncologist is in mid April...thinking to discuss further....
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Sometimes oncologists take
Sometimes oncologists take calculated risks. After my hysterectomy (uterine, cervix, and fallopian tubes were removed, ovaries were left) the pathology report revealed a grade 1 stage 2 (less than 50 percent invasion, the stage 2 is due to minimal invasion of cervix) endometrioid cancer (the garden variety) AND scant number of atypical cells in the pelvic wash. The fallopian tubes were negative for cancer. My doctor must have decided that due to my age (44) and the grade of the tumor (1) and the histology (endometrioid, the least aggressive form) just observing should be sufficient for me. I was happy to hear I was done with this chapter of my life and didn't question this knowledgeable person who was basically telling me not to worry. I didn't seek a second opinion and in three short months I had a recurrence of that low grade cancer on my right ovary (a 6.9 cm mass) How I wish that I sought a second opinion at that time.
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thanks mugsbugsMugsBugs said:Saltycandy13 - Good News!
Congratulations on the good pathology report! That is awesome.
Earlier this month I took my Dad to the pulmonologist (he has emphysema and fibrosis). There were some bright white specks on his scan and the doctor asked him ‘Have you been around chickens?’ Dad grew up on a farm and in his early 20s lived in a rooming house that was converted from a chicken coop. Apparently there is a virus that is non-threatening but manifests itself as small scar tissue in the lungs. I could see them, small bright dots. The rationale For this story is to show that probably only a pulmonologist would recognize this type of nuance in a scan.
When I get a chance, I want to post my entire pathology report here. Maybe it will help someone. It was Adenocarcinoma Grade 1 with no invasion of anywhere else. No further treatment needed. I am hoping the specifics will help and explain what exactly was going on in my reproductive system.
Karen
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