Question asked by: 
Date asked: 
Jun 2015

Last September I was diagnosed with stage 1C 2 Grade 2 edenometriode adenocarcinoma of the ovary and in October Grade 1 1A endometrial adenocarcinoma. I was supposed to have had six months of chemotherapy but only had five months, I was poorly so they decided not to give me my last one. I don't understand the grades very well or the stages. Will my cancer come back at all? 

Will my cancer come back at all?
Stage refers to how far the tumour has spread - this is the most important thing of all.
Response by Professor Iain McNeish, Professor of Gynaecological Oncology

The situation that is described is surprisingly common, namely what appears to be synchronous primary endometrioid tumours in the ovary and endometrium.  The big question is whether they are genuinely two separate tumours or whether one tumour has moved to the other.  Answer is that it is very difficult to say for certain - however, the fact that, as in this case, one tumour is grade 2 and the other grade 1 does suggest that they are genuinely two separate tumours that have arisen at the same time.

In terms of the term 'grade' - this simply refers to how abnormal the cells look. Grading comes on a 3 points scale, 1 - 3.  Grade 1 tumours, also known as well-differentiated, contain tumour cells that are relatively normal looking (i.e. in this case, they still look relatively like normal endometrial tissue).  Grade 3 tumours, also known as poorly differentiated, contain very abnormal looking tumour cells (rapidly growing, don't look much like the organ/tissue from which they arose).  Grade 2 is somewhere in the middle. 

Grading matters because, by and large, grade 1 tumours are slower growing and less aggressive than grade 2 or 3.

Stage refers to how far the tumour has spread - this is the most important thing of all.  So, in this case, the ovarian tumour is stage 1C2, which ovarian cancer confined to one ovary but the tumour either burst before surgery or there was evidence of tumour on the outside of the ovary when the pathologist examined it.  This is still classified as 'early stage' ovarian cancer.  The endometrial cancer was stage 1A, which is the earliest (i.e. best) stage that there is.

To answer the final question about whether it will come back - it is completely impossible for me to say what might happen to any one woman.  However, stage 1C2 grade 2 endometrioid cancer of the ovary has a good prognosis - some women will recur, but this is a minority, and most can expect to be well in the long term. Stage IA grade 1 endometrial cancer has an excellent prognosis.