Introducing Dr P

Today I went to the Instutit Gustave Roussy which is THE big cancer center in France. It's in one of the Parisian suburbs and it's a huge hospital complex that does nothing but cancer.

Looking at the website yesterday to orient myself I was really hit by how serious this is - I mean this is the Big Guns place, the center that partners with Kolinska and MD Anderson for Europe. Gulp. But the truth is, this is where the best experts are, and my friend Sophie had offered to get me in to see the endometrial expert, and with our recent questions I jumped at the opportunity.

Arriving at the IGR campus it was full-on cancer - bald, thin patients on IV drips sitting on the benches outside before you enter into the most modern and American-looking hospital I've seen since I've been in Europe. The system and the hospital is very organiszed, very much like the US (except maybe the price, which was ... €22, the lowest physician consult fee that exists in France). Crazy.

Dr P was thorough and impressive. She took her time to take the full history, re-read all the various test results with me to make sure she had the context, and basically immediately estabished herself as the most trusted of all these docs I've seen. Her perspective is also different from both Dr M and Dr C - Dr C is a general oncologist who knows nothing about endomtrial cancer, and Dr M is a gynecologist trained and specialized in gynecological cancer. Dr P is a oncologist trained in gynecologic cancer.

Bottom line from Dr P :

• She believes that while the cancer is staged early, the only real way to know if it has had any invasion is a hysterectomy. A D&C can only catch so much. So there is a risk that there is invasive cancer still present, and that even after hormone treatment it would still be present.
  
• She sees a risk in doing a stimulation for IVF on the endometrium
• She sees a risk in doing a pregnancy on the endometrium
• She does not believe we need to move with enormous speed, but that we shouldn't take forever to decide either
• Her recommendation would be to have a hysterectomy now and keep the ovaries. To do an ovarian stimulation afterwards provided the hysterecomy pathology comes back clean. At some point in the future might or might not remove ovaries. She would NOT do a stimulation on the current endometrium, however, she thinks this could stimulate small cancer cells that might be present.
  
• She is going to discuss this next week or the following one at the cancer board, where it would be also discussed w a surgeon and they would also give their opinion on whether or not to have the progestin treatment during the summer (presumably the hysterectomy would be in late August).
  

One thing that is for sure is that I had enormous confidence in the facility and in the doctor.

Her suggestion seemed the smartest middle road that I've heard to date, and is not one of the options I've heard from the docs nor seen discussed in the clinical literature.