Post-Surgery Follow-Up for Endometrial Cancer: Essential Tests and Guidelines

Post-operative follow-up examinations for endometrial cancer?

Hello, Director Cao.
In March of this year, I underwent a hysterectomy and oophorectomy due to stage I endometrial cancer.
My attending physician advised that I should have a chest X-ray and blood tests every three months, and a CT scan for follow-up once a year.
However, when I returned to the hospital for my check-up this month, the original attending physician had left, and the new physician stated that the previous tests were unnecessary.
They mentioned that I only need to have blood tests to check cancer markers, and that the other tests are meaningless, so I don't need to do them anymore.
Additionally, the original physician said that since the tumor was removed, I could eat foods containing estrogen and hormones without restriction.
However, the new physician advised that I should still avoid foods containing estrogen and hormones.
There is a discrepancy between the two physicians' recommendations, and I would like to ask for your opinion and advice on these two issues.
Thank you!

mei, 40~49 year old female. Ask Date: 2017/12/05

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, each physician may have a different approach.
Generally, tests such as blood tests for cancer markers, chest X-rays, CT scans, and Pap smears can be performed, but the choice varies among physicians.
As for estrogen, it is advisable to use it sparingly if possible.
Wishing you good health.

Reply Date: 2017/12/05

More Info

Post-surgery follow-up for endometrial cancer is crucial for monitoring potential recurrence and managing any long-term effects of treatment. Your experience highlights a common concern among patients regarding the consistency of medical advice, especially when transitioning between different healthcare providers.

Follow-Up Testing
1. Routine Imaging and Blood Tests:
After surgery for endometrial cancer, the standard follow-up typically includes:
- Chest X-ray: This is often done every three to six months for the first few years to check for any signs of metastasis, particularly to the lungs.

- Blood Tests: Monitoring tumor markers, such as CA-125, can provide valuable information about the presence of cancer. Elevated levels may indicate recurrence.

- CT Scans: Annual imaging, such as a CT scan of the abdomen and pelvis, is recommended to assess for any signs of recurrence or metastasis.

The initial recommendation of your previous physician to have both chest X-rays and blood tests every three months, followed by annual CT scans, aligns with standard practices. The new physician's suggestion to rely solely on blood tests may not be comprehensive enough, especially considering that endometrial cancer can recur in various forms.
2. Individualized Follow-Up:
It's essential to have a follow-up plan tailored to your specific situation. Factors such as the stage of cancer at diagnosis, histological type, and any additional treatments (like radiation or chemotherapy) can influence the frequency and type of follow-up tests needed.

Dietary Considerations
Regarding dietary restrictions, the advice can vary based on individual circumstances and the evolving understanding of cancer treatment and nutrition.
1. Hormonal Foods:
The concern about estrogen-containing foods stems from the understanding that endometrial cancer can be hormone-sensitive. While some studies suggest that certain foods may influence hormone levels, the evidence is not definitive. The previous physician's advice to avoid such foods may have been more conservative, while the new physician's stance could reflect a more relaxed approach based on the current understanding of dietary impacts on cancer recurrence.

2. Consultation with a Nutritionist:
It may be beneficial to consult with a registered dietitian or nutritionist who specializes in oncology. They can provide personalized dietary recommendations based on your treatment history and current health status.

Recommendations
1. Seek Clarification:
Given the conflicting advice from your two physicians, it would be prudent to seek clarification from your current healthcare provider. You might consider asking for a detailed explanation of the rationale behind the changes in follow-up protocols and dietary recommendations.

2. Consider a Second Opinion:
If you feel uncertain about the guidance provided, seeking a second opinion from another oncologist or gynecologic oncologist can provide additional insights and help you feel more confident in your follow-up plan.

3. Stay Informed and Engaged:
Being proactive in your follow-up care is essential. Keep track of your symptoms, any changes in your health, and maintain open communication with your healthcare team. This engagement can significantly impact your long-term health outcomes.

In summary, while the follow-up plan should ideally include a combination of imaging and blood tests, individual circumstances may warrant adjustments. Dietary recommendations should also be personalized, and consulting with specialists can provide clarity and support. Your health and peace of mind are paramount, so advocating for your needs and preferences in your care is crucial.

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