This case involves a middle-aged female patient who underwent a hysterectomy after a growth was discovered and originally diagnosed as a low-grade adenocarcinoma. Some time later, the Plaintiff was seen by another physician who performed additional testing, who determined the mass to be a serous carcinoma. The patient did not receive any follow-up or chemotherapy after the surgery due to the presumed low-grade nature of the mass. Some time later, the patient began to manifest shortness of breath, which was determined to be linked to the development of metastatic lung cancer from the patient’s original mass.Â
Question(s) For Expert Witness
- 1. Should the testing have been done during the original resection procedure?
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2. Would earlier detection have altered this patients treatment plan?
Expert Witness Response E-006779
The testing done here is not standard for endometrial cancer diagnostics. Determination of serous carcinoma is based on H&E staining, not p53 stain. p53 over expression in an apparent endometrioid carcinoma is insufficient for determination of serous carcinoma. A GYN pathology expert is more appropriate for answering this question. Most gyn-oncologists would give chemotherapy to a stage 1 serous cancer. However, many would not have if the lesion had been confined to a polyp. There is not a uniformly accepted standard. Many clinicians would have re-operated and re-staged a serous cancer treated only with hysterectomy, removing lymph nodes and doing peritoneal biopsies. Had these been abnormal, then treatment would definitely have been instituted (chemotherapy +/- radiation, depending on results). However, the fact that disease has only recurred in this area suggests that biopsies would have been negative and treatment would not have changed. 5y survival for a Stage I serous endometrial cancer is about 50%, absent metastases. Intervention is likely to have reduced but not eliminated risk for pleural recurrence.
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