36F with FIGO IA, Grade 2 endometrioid ovarian cancer, is completion surgery necessary?
I’m a 36-year-old woman, non-smoker, currently recovering from laparoscopic surgery. I’m looking for informed opinions while I arrange a second opinion with a gynecologic oncologist.
I had surgery for a \~10 cm left ovarian cyst that was initially thought to be an endometrioma. During surgery, the cyst was ruptured/opened **inside a controlled retrieval bag**. There was no free spillage into the abdominal cavity.
The pathology has now shown:
**Diagnosis:** Endometrioid carcinoma arising in a background of endometriosis
**Grade:** G2, moderately differentiated
**Stage:** pT1a / FIGO IA
**Tumour:** 10 cm, confined to the left ovary
**LVSI:** Not identified
**Ovarian surface involvement:** Not identified
**Implants:** Not applicable
**Lymph nodes:** Not submitted
**Peritoneal/ascitic fluid:** Not submitted
The other specimens were reassuring:
Right ovarian cyst: endometriosis, **no atypia or malignancy**
DIE nodule: endometriosis, **no atypia or malignancy**
Fibroid: benign leiomyoma
Immunohistochemistry:
PAX8: diffuse positive
ER: diffuse positive
p53: mutational-type
WT1: negative
My doctors are recommending a **completion staging surgery**, including removal of my both my left and right ovary, both fallopian tubes, uterus, omentum and all pelvic/ para-aortic lymph nodes including PNLD.
Their explanation is that removing everything would significantly reduce my risk of recurrence.
I understand the rationale, but I’m 36 and my right ovary currently has no evidence of cancer. Removing it would cause immediate surgical menopause, potentially for decades. I’m also ER-positive, so I understand that HRT may be a complicated question afterward.
My main questions are:
For **FIGO IA, Grade 2 endometrioid ovarian carcinoma**, is removal of the healthy contralateral ovary and uterus routinely recommended in someone my age?
Is **completion surgical staging** necessary because lymph nodes and peritoneal washings weren’t obtained during the first surgery?
Could staging potentially be performed while **preserving the right ovary**, assuming it looks normal and there is no evidence of disease elsewhere?
Does G2 status significantly change the recommendations compared with G1?
Does the **p53 mutational-type staining and diffuse ER positivity** change the risk assessment or management?
Would you recommend a second pathology review and/or molecular testing such as **MMR/MSI, POLE and other molecular classification** before deciding on further surgery?
If complete staging is negative, would chemotherapy normally be considered for this particular presentation?
Is there evidence that removing the remaining healthy ovary and uterus actually improves overall survival or recurrence outcomes in someone with my specific stage and histology, as opposed to simply eliminating the possibility of a future ovarian/uterine primary or recurrence?
I’m not looking to replace my oncologist’s advice with Reddit advice. I’m trying to understand whether **“complete staging” and “remove all reproductive organs” are necessarily the same thing in my situation**, and what questions I should take to my second-opinion gyn-oncologist.
I can provide the full pathology report if helpful.