How do you manage a patient with an endocervical cancer indeterminate for endometrial or cervical origin status post TAH/BSO and sentinel node biopsy?
The patient is >40 yo with Lynch syndrome and a history of endometrial hyperplasia status post R0 TAH/BSO with SLNBx for a 5.2 cm, grade 3 adenocarcinoma of the endocervix with 85% cervical stromal invasion and no LVI. It is ER(patchy, weak), PR(-), p16(focal +), vimentin (-), CEA-M (focal +). GynOnc did robotic TAH/BSO presuming this was of endometrial origin which would be Stage II. Pathologist thinks this is FIGO IB3 cervical carcinoma.
Will additional HPV gene, p53, or other tumor testing clarify the diagnosis?
Does it matter?
Do you favor intravaginal brachytherapy alone if endometrial or with either diagnosis is pelvic radiotherapy with or without an intravaginal brachytherapy boost preferred?
Answer from: Radiation Oncologist at Community Practice
P16 and CEA positivity (although focal) favor cervical cancer. Can also do high risk HPV and p53 as suggested. Either way, the patient looks like they had a simple hysterectomy done and would favor EBRT plus brachy (would consider adding weekly cisplatinum if the overall picture is cervical).
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Answer from: Radiation Oncologist at Academic Institution
With active Lynch Syndrome and a history of endometrial hyperplasia, I would likely favor treating this as an endometrial primary of the lower uterine segment.Focal p16+ positive makes me think less likely cervical primary as most endocervical adenocarcinomas are reportedly diffusely p16+ (McCluggag...
Answer from: Radiation Oncologist at Community Practice
I would do external beam, and radiation therapy to pelvis with chemotherapy. I would also do the vagina brachytherapy. As far as chemotherapy, I think cisplatinum based chemotherapy has shown more response with the radiation therapy.