follow-up after surgery for high-grade serous carcinoma?

So glad to hear your good news!  My suggestion for you would be to get a second opinion. There was a great deal of confusion when my pathology came back and I asked for and received a second opinion from MD Anderson.  I believe most insurance situations allow second opinions.  This is an important decision, and it's important for your healing and your peace of mind to have clarity about your treatment plan.  (At first I was told medicine, then radiation, then chemo and radiation.  Upon completion of chemo, I went back again for a second opinion, and it was decided after much debate to reserve radiation for recurrence.  I did not have serous; rather endometrioid endometrial adenocarcinoma.  First pathology said Stage IIIA, Grade 1.  Second opinion said Stage IVB, Grade 2.  Can't get much worse than that, so I didn't get a third opinion.)  

 I, too, was a 1a USPC in 2017 and was going to do only observation. However, my oncologist and the ladies on this board convinced me to do more. I have had some recurrence even with followup treatment. This is a stubborn cancer.

If I were you, I'd get another opinion. 

It is good your cancer did not spread outside the uterius.  But when describing the tumor they usually say what percentage to malignancy penetrated the uterine wall.  When you say it was 1 cm does it mean it penetrated the wall 1cm?   Stage 1A has lots of levels.  I think determining treatment is better when using the percent of unterine wall invasion.  It quickly becomes the standard of treatment to have what Zsa Zsa describes.  All 1A 's are not the same.  I would get a second opinion.  And read your path report again.  What does the 1cm mean?  

As you can see from the prior posts, there's been enough experience with "caught early" serous uterine cancer that none of us feel comfortable with "watch and wait" treatment following surgery. This type of uterine cancer is a real **** that you need to be equally aggressive going after as it is about coming back. Front line treatment is your best shot at a cure, so even though chemo and/or radiation is not fun, I wouldn't feel relieved about getting out of doing it for your diagnosis. Get a second opinion, even a third if you need a consensus, but your surgeon's recommendation for just check-ups is raising a lot of alarm bells here! 

I remain NED. I believe my UPSC was staged at 1a, although I also had endometrial adenocarcinoma staged at 1b. Following two "face-to-face" second opinions and one conducted by e-mail with a gyn/onc at Mayo, I opted to add chemotherapy and brachytherapy to my open abdomen hysterectomy surgery. Please read my "About me" page.

Sending big hugs as you contemplate the possibility of further treatment.

Sally

jjtrim said:

Another vote for a 2nd Opinion

After surgical staging, my mother was diagnosed a stage 1a UPSC, confined to an endometrial polyp.  Her oncologist told her no further treatment was necessary. We were not given an alternative. My mother's cancer recurred in 14 months with widespread metastasis, now stage 4B.  Please, please, please get a second opinion - and strongly consider the recommended adjuvant therapy for this agressive cancer - 6 carbo/taxol and brachy.  Of course, there are plenty of people who will recur even with the adjuvant therapy, but at least you will have some peace of mind that you did everything you could.  

jjtrim, I was thinking exactly of what happened to your mother when I was writing urging a second opinion, but I didn't want to say it.  Thank you for chiming in.

kansasgal said:

10 years later

I remain NED. I believe my UPSC was staged at 1a, although I also had endometrial adenocarcinoma staged at 1b. Following two "face-to-face" second opinions and one conducted by e-mail with a gyn/onc at Mayo, I opted to add chemotherapy and brachytherapy to my open abdomen hysterectomy surgery. Please read my "About me" page.

Sending big hugs as you contemplate the possibility of further treatment.

Sally

Sally, thank you!  I am so grateful when I see long term survivors coming back to post.  It gives all of us great hope!!

smargaret said:

Path report

Here's what it says with regard to the uterine wall.  My understanding is that this is why the surgeon said no radiation or chemo necessary, but I want to check with the oncologist at my post-op.

  Uterus, endometrium, hysterectomy and bilateral salpingo-oophorectomy
-  HIGH GRADE SEROUS CARCINOMA, MICROSCOPIC FOCI, < 1 CM
-  TUMOR LIMITED TO ENDOMETRIUM (NO MYOMETRIAL INVASION IDENTIFIED), pT1a
-  NEGATIVE FOR LYMPHOVASCULAR INVASION
-  PARAMETRIUM, CERVIX, OVARIES AND FALLOPIAN TUBES NEGATIVE
-  AJCC PROGNOSTIC STAGE GROUP (8th Edition 2018):  pT1a N0 M0 = IA

The < means less than 1cm, and it says microsopic so small.   And there is no myometrial invasion.   The levels of 1A can include up to 50% myometrial invasion and you have 0%.   According to all reading, Uterine serous carcinoma limited to the endometrium does include observation only as the treaatment after full surgical staging.  Your doctor knows that the prognosis does not change when recieving treatment.   The recurrence rate is the same for some reason.  This explains your doctors recommendation.  AND the extremely difficult decision ahead for you.  To have treatment or not.  The second opinion will be very helpful in making that decision.  Also, I would request that your tumor cells be tested for genetic mutations.   It can help determin the aggressiveness of your tumor.  I think there was an article recently on the board that said this testing is now considered useful and is covered by insurance.