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 鈥淪tage 1, Grade 3, size 4.5 cm undifferentiated carcinoma with myoinvasion of under 50 per cent, clear lymph nodes and margins.鈥� My case was discussed at a tumour 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 tumour. 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.
听听 听
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鈥檛 seem to me that the two opinions here are of equal weight.
The first opinion is the consensus of a tumour 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 little; however, the standard of care for most women with 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鈥檛 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. 听
Dear Dr. Roach: There is a question that has intrigued me for years: What is the purpose of underarm and pubic hair? I guess, for that matter, what is the purpose of any body hair and hair on your head?
B.H.
Hair provides protection from the sun and helps regulate body temperature. Many evolutionary biologists believe our distant ancestors began losing most body hair when we began walking upright.
Axillary (underarm) and pubic hair are thought to be conserved because they reduce friction, wick moisture away from the skin, provide a small degree of protection and as part of sexual selection, possibly due to pheromones, hormones that act outside the body to attract others.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to听 [email protected].
