Doc: With many opinions, whose do you trust?
Dear Dr. Roach: I was diagnosed with endometrial cancer about seven weeks ago. I had a complete hysterectomy four weeks ago. The pathology report came back as “Stage 1, Grade 3, size 4.5 cm undifferentiated carcinoma with myoinvasion of under 50 percent, clear lymph nodes and margins.”\
My case was discussed at a tumor board, and at my two-week check-in with the surgeon/oncologist we went over a plan for treatment. He suggested internal radiation and three chemo sessions due to the size and grade of the tumor. Following that appointment, I met with my previous oncologist to discuss my tamoxifen medication, which I have been taking for five years, since breast cancer treatment.
The second oncologist had a difference of opinion, stating that he would recommend the internal radiation but no chemotherapy. He believes the tamoxifen was the cause of the uterine cancer, which is another difference of opinion between the two oncologists.
I am very conflicted and wondering how to decide on whether to do the additional chemo treatment.
Dear C.R.: I usually advise patients to seek a second opinion before making a critical medical decision, such as surgery or chemotherapy, if time permits. When provided with two opinions of equal weight, I will sometimes recommend getting a third opinion.
In your case, however, it doesn’t seem to me that the two opinions here are of equal weight.
The first opinion is the consensus of a tumor board, which usually includes surgeons, oncologists, radiation oncologists, diagnostic radiologists, pathologists, surgical nurses and pharmacologists.
I would recommend you give greater weight to the combined expertise of the group, as both common sense and studies have shown that a recommendation by consensus of experts is more likely to be correct than that from a single individual.
Of course, this is not always the case, but it is so frequently that I would give greater weight to the panel.
I am neither a gynecologic nor a medical oncologist, and my opinion in your specific case is worth very little; however, the standard of care for most women who have endometrial cancer has been to include chemotherapy.
Finally, endometrial cancers caused by tamoxifen (a compound with some estrogen and some anti-estrogen characteristics) tend to be well-differentiated, and yours is undifferentiated, which makes me, as a nonexpert, lean toward more aggressive therapy.
If you aren’t sure, I would find a gynecologic oncologist, since they are the real experts in deciding whether chemotherapy gives additional benefit to the planned radiation after what sounds like successful surgery.
Email questions to ToYourGoodHealth@med.cornell.edu.