Uterine (Endometrial) Cancer
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 âï¿½ï¿½decrease in degree of periaortic lymphadenopathy with persistent evidence of matted lymph nodesâï¿½¦âï¿½ï¿½ Pelvic MRI documented âï¿½ï¿½decrease 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 hysterectomyâï¿½¦âï¿½ï¿½ 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, âï¿½ï¿½terrible night sweats,âï¿½ï¿½ and poor sleep.
JK subsequently followed her regimen with great determination. Seven months later, in December 1991, repeat MRIâï¿½ï¿½s 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 hemipelvisâï¿½¦.
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 âï¿½ï¿½There is no identified pelvic lymphadenopathy.âï¿½ï¿½ The official report of the abdominal MRI states âï¿½ï¿½There is no evidence of significant periaortic or periportal lymphadenopathy.âï¿½ï¿½
MRI studies completed 14 months later, in March 1994 confirmed âï¿½ï¿½There is no distinct evidence of metastatic or recurrent disease.âï¿½ï¿½
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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1. Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo, DL, Jameson JL. Harrisonâï¿½ï¿½s Principles of Internal Medicine, 16th Edition. New York: McGraw-Hill; 2005:556.
2. Aalders J, Abeler V, Kolstad P, Onsrud M. Postoperative external irradiation and prognostic parameters in stage I endometrial carcinoma. Obstet Gynecol. 1980;56:419-27. [Abstract]
3. Creutzberg CL, van Putten WLJ, Koper PCM, Lybeert MLM, Jobsen JJ, et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. Lancet. 2000;355:1404-11. [Abstract]