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In 2004, 40,300 new cases of cancer of the uterine lining were
reported, along with 7,000 deaths. (1) Fortunately, in about 75%
of all cases, the disease is diagnosed at an early stage when surgery
can be curative. For decades, radiation to the pelvis has been routinely
recommended as adjunctive post-surgical treatment for localized
endometrial cancer. However, the data from the only two controlled
clinical trials completed to address the effect of radiation, published
in 1980 (2) and 2000 (3) respectively, show overall no survival
advantage compared to surgery alone. In certain subgroups, the authors
report patients receiving radiation actually have shortened survival
times.
Once metastatic, uterine cancer resists chemotherapy and usually
kills quickly, with a median survival reported in the range of 6-8
months, and a 5-year survival rate at 5% or less. Hormonal blockade
with the synthetic progesterone Megace or similar drugs can offer
temporary benefit in some 20% of patients with widespread disease,
but the responses usually are usually short lived.
Patient JK: A 16-Year Survivor
Patient JK is a 62 year-old women who had been in good health when
in the fall of 1990, she required hospitalization for two episodes
of deep venous thrombosis. She was placed on Coumadin, but shortly
thereafter suffered an episode of severe vaginal hemorrhage. When
the bleeding persisted, in December 1990 she underwent a D&C,
which revealed endometrial carcinoma. After a CT scan in January
1991 showed extensive abdominal and pelvic lymphadenopathy, she
underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy.
The pathology report describes endometrial adenocarcinoma with
areas of squamous differentiation, high nuclear grade (FIGO grade
III), and papillary serous carcinoma, one of the most lethal of
uterine malignancies. The tumor had spread to the left ovary, obliterating
the fimbriated end of the left Fallopian tube. Biopsies of the peritoneal
cul de sac as well as the rectal serosa confirmed metastatic disease,
and due to the extent of metastasis, her doctors warned of a very
poor prognosis.
Postoperatively, JK met with a radiation oncologist who insisted
treatment begin at once. Before agreeing to any therapy, JK decided
to consult with a second oncologist in a Southern tertiary care
center. Once again, radiation was aggressively pushed as essential
to delay spread of her aggressive disease. However, JK decided to
refuse all orthodox treatments, instead choosing to medicate herself
with a variety of nutritional supplements including high dose vitamin
C and red clover tea.
An abdominal MRI in March 1991 showed a “decrease in degree of
periaortic lymphadenopathy with persistent evidence of matted lymph
nodes…” Pelvic MRI documented “decrease in the degree of diffuse
pelvic lympadenopathy although there is persistent evidence of pelvic
mass lesion most notable in the left hemipelvis. There is evidence
of surgical defect presumably from previous hysterectomy…” So with
surgery, there had been improvement, though clearly extensive disease
remained.
About that time, after learning of our work, JK decided to pursue
my therapy. When first evaluated in my office in April 1991, she
reported persistent fatigue, a substantial recent weight loss of
15 lbs, “terrible night sweats,” and poor sleep.
JK subsequently followed her regimen with great determination.
Seven months later, in December 1991, repeat MRI’s showed no change
in the periaortic lymphadenopathy as compared with the study of
March 1991, but significant regression of the pelvic adenopathy
and the pelvic mass in the left hemipelvis. The official report
states:
Compared to the study of 3---91, there is continued improvement
with near complete resolution of previously seen pelvic lymphadenopathy.
Currently, there is no appreciable residual mass lesion present
within the left hemipelvis….
Thereafter, JK continued her nutritional program diligently, with
reported improvement in her general health. MRI studies of the abdomen
and pelvis in January 1993, after she had completed some 20 months
on therapy, indicated that the previously noted extensive disease
had completely resolved. The pelvic scan revealed “There is no identified
pelvic lymphadenopathy.” The official report of the abdominal MRI
states “There is no evidence of significant periaortic or periportal
lymphadenopathy.”
MRI studies completed 14 months later, in March 1994 confirmed
“There is no distinct evidence of metastatic or recurrent disease.”
JK followed her regimen faithfully until early 1997, when I last
had formal contact with her. At that time, six years from her diagnosis
of metastatic aggressive histology endometrial cancer, she remained
disease free and generally in good health. She subsequently continued
her therapy in a reduced way, and at last report, now nearly 16
years from diagnosis, is alive and apparently doing well.
This case is straightforward: the patient was diagnosed with extensive,
aggressive histology uterine cancer, including papillary serous,
one of the most deadly subtypes. The surgeon could not excise all
the visible cancer, as MRI studies after surgery documented. She
then experienced complete regression of her advanced disease while
following her nutritional program, and remains alive 16 years later.
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