Chemo First, Then Radiation, and Perhaps Surgery

This lady has a clinical stage IIIB endometrial cancer (involvement of vaginal wall) and image evidence highly suspicious for International Federation of Gynecology and Obstetrics stage IIIC2 disease (para-aortic adenopathy) (1). In addition, magnetic resonance imaging also suggests parametrial spread of disease. Staging and/debulking surgery is the standard initial therapy for endometrial cancer. In high-grade histology such as this case, an optimal outcome requires that staging surgery is comprehensive, and where extrauterine disease is grossly apparent, all visible disease resected to R0 (no residual disease) (2).

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