How do you manage a patient with an endocervical cancer indeterminate for endometrial or cervical origin status post TAH/BSO and sentinel node biopsy?

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).

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...

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.