Endometrial Cancer
CASE 1 – Madam ACS (Endometrial)
Madam ACS, a 64-year-old Chinese lady presented to us with a recurrent endometrial cancer in a very advanced state. About 6 years earlier, she had an endometrial cancer diagnosed in Singapore and underwent a laparoscopic hysterectomy. She remained well until a year prior to this presentation, when she developed abdominal discomfort and vaginal bleeding. She sought alternative treatment, including traditional chinese medicine for a period of 9 months, during which her cancer progressed, and her condition deteriorated. At the time of presentation, she was completely incapacitated, and had severe bilateral lower limb swelling, with oedema up to her waist. She had bilateral deep vein thrombosis involving the common iliac veins, severe anemia with HB of 7.2 g/dL, and bilateral obstructive uropathy. Her cancer was huge, filling the entire pelvis up to the upper half of the abdomen, and the tumor had invaded through the pelvic side wall into the gluteus muscle. This growth was palpable around her right buttock. She was considered not suitable for chemotherapy, and surgery, and the only option offered by the oncologist was palliative radiotherapy.
She was extremely reluctant to try any conventional treatment, but following many rounds of counselling, agreed to an integrative approach. She was admitted and received blood transfusions, bilateral ureteric stenting, and anticoagulants for the deep vein thrombosis. With concomitant use of high dose IVC, a palliative dose of radiotherapy was first administered. As she showed very good response to these initial therapies, we proceeded to complete the full course of radical radiotherapy. At the end of two months, this patient had made a complete recovery, and returned to near-normal function.
This case is an excellent illustration of the powerful synergies that are possible by the appropriate use of the best tools in conventional oncology and the healing powers inherent in the patient. The ability to convert a palliative situation into a curative outcome demands an oncologist who is prepared to think out of the box. As this was not just a locally advanced disease, and radiotherapy was only targeted at the abdominal pelvic mass and the gluteal mass, the complete disappearance of cancer would likely not have been possible if not for the abscopal effects from an immune mediated response.
An abscopal (Latin: ab-scopus, away from the target) response describes tumor regression at sites distant to an irradiated field. It is seen in patients with various types of metastatic tumors receiving palliative radiotherapy to a single metastasis. In our experience, the addition of immunotherapy and metabolic and nutritional enhancement can work synergistically to improve outcomes and higher rates of abscopal benefits.
We have observed and recorded abscopal responses in non-irradiated tumors. When combined with immunotherapy, local radiotherapy can induce an immunogenic type of tumor cell death that contributes to pro-inflammatory signaling, improves dendritic cell cross-priming of effector T-cells, increases T-cell diversity, enhances lymphocyte trafficking and helps overcome the immunosuppressive tumor micro-environment (TME). Dendritic cells have a central role in immunological responses. The differentiation of distinct subsets of dendritic cells from bone marrow precursor cells can be induced by genetic factors (eg. Flt3-Ligand) and granulocyte-macrophage colony stimulating factor (GM-CSF).
Case 2 - Mrs. D (55 YO)
Mrs. D, presented with post-menopausal bleeding for 3 months. Endometrial biopsy confirmed an adenocarcinoma of the endometrium, and MRI of the pelvis showed myometrial invasion with pelvic lymph node enlargement. She had stage 3 cancer of the endometrium.
A laparoscopic surgery (minimally invasive) was employed, and a radical hysterectomy and pelvic lymphadenectomy was performed.
Pre-operative optimization was followed with post-operative HDIVC, Vit. B17 and metabolic manipulation with a ketogenic diet.
On regular and close monitoring, she has remained cancer free for the last 5 years.
Typically, such a patient would have been offered adjuvant radiotherapy and/ or chemotherapy. However, Mrs. D declined this conventional treatment and opted to find a healing-based solution.
This case illustrates the possibilities and potential benefits of adjuvant therapy that addresses the root cause and by improving the immune system to fight cancer.
CASE 3 – MDM LCE 38 YO
Madam LCE was referred to me with a diagnosis of endometrial cancer. She was 38 years old with four children and all of them were delivered through caesarean sections. She had a three-month history of heavy and irregular menstruation and endometrial biopsy confirmed a moderately differentiated adenocarcinoma of the uterus. She weighed 98 kg and was diabetic. Her uterus measured 20 cm.
She agreed to undergo a hysterectomy but was keen on conservation of her ovaries. She had pre-operative optimization with antioxidants as well as high-dose intravenous vitamin C. Surgical procedure was uneventful and histopathology examination confirmed stage 3B endometrial cancer with involvement of pelvic lymph nodes.
As is customary she was referred to the medical oncologist for adjuvant chemotherapy and radiotherapy. However, she was aware that radiotherapy would damage the ovaries and render her to be prematurely attaining menopause. She therefore was keen to first undergo healing-based therapy instead of adjuvant chemotherapy.
Three months after surgery she had her first pet CT scan and the results showed there was no evidence of metabolically active disease.
She has managed to lose a considerable amount of weight and reversed her prediabetic condition. Follow-up and surveillance over the last seven years has shown her to be cancer free.
DISCUSSION Endometrial cancer is an increasingly common cancer seen in industrialised countries and associated with obesity and affluence. The standard treatment consists of surgery, followed with chemotherapy and radiation in the more advanced cases. Madam LC chose a different way to deal with her cancer and has successfully overcome her cancer using a combination of surgery as well as retain her ovaries. As endometrial cancer is an oestrogen dependent cancer it is customary for removal of the ovaries in advance disease. Of course, this would mean she would go into premature menopause and the problems associated with this and for a young woman at 38 can be an extremely difficult situation to deal with. By addressing her underlying and predisposing factors for the cancer and optimising her healing potential she was able to overcome her cancer and retain her ovaries as well. And by avoiding adjuvant radiotherapy to the pelvis, she was able to retain her normal sexual functions.