Patient: Description of the condition (time of onset, main symptoms, hospital visited, etc.): The patient was 58 years old, with a history of right breast cancer, ductal invasive grade 2, 11 years postoperative, no recurrence, taking tamoxifen for three years after surgery. In early February of this year, irregular vaginal bleeding was detected on negative ultrasound, with irregular echogenicity in both uterine cavity and cervix, suggesting an occupying lesion to be further examined for cancer. The biopsy and the consultation pathology showed that “no cancer was seen in the annulus, chronic cervicitis, hyperplasia was adenocarcinoma (cervical) (highly differentiated) and endometrial examination was recommended to determine the source”. The pathology showed that “the uterine body was 5*5*4.5 cm, the cervical canal was 3 cm long, and the total length of the cervix was 5.5 cm. A cauliflower-shaped mass of 6.5*2.5*3 with a soft pea-like texture was seen from the uterine cavity to the cervix. Immunohistochemistry CEA-, nm23+, Ki67 positive expression 50%, P53-, ER+, supported endometrioid adenocarcinoma grade 2, invading the muscle wall to a depth of less than 1/2, and cancerous emboli were seen in the vasculature. No cancer was seen in bilateral fallopian tubes, ovaries and lymph nodes (right and left inguinal, right and left extraskeletal, right and left common skeletal, and right and left closed foramen). The pathology in another large hospital showed that, unlike the above, “it supported highly differentiated adenocarcinoma, invading more than 1/2 of the muscular layer, with adenocarcinoma cells seen in a few vessels”. . Another chemotherapy was administered after radiotherapy. All indicators are normal except CEA, which is slightly higher. What I would like to ask you is whether further chemotherapy or other treatment is needed. Because immunohistochemistry only returned ER+, no PR, do I need endocrine therapy and how to set the course of treatment? Zhao Xiaodong: 1) According to the current staging, this patient belongs to stage 2 endothelial carcinoma with vascular infiltration, and the general postoperative treatment can choose radiotherapy alone or radiotherapy combined with chemotherapy. The treatment plan of our hospital is similar to the patient’s current treatment plan, radiotherapy combined with chemotherapy. 2) Our hospital generally does 2 chemotherapy sessions after radiotherapy if the patient’s condition allows, this patient can choose to do another chemotherapy session. 3) The significance of postoperative adjuvant endocrine therapy: according to the current evidence of inquiry medicine, postoperative adjuvant endocrine therapy cannot improve the prognosis, but can also increase weight, increase the risk of cardiovascular disease and There is no need to check PR. Patient: Thank you, Dr. Zhao, that means the patient has already had four treatments, which is already enough, right? Patient: Sorry, misunderstood, you mean you can do another one, that is a total of 5. The local hospital said at the beginning that it was 6 times chemotherapy, I was afraid of over-treatment Zhao Xiaodong: 2 times of chemotherapy after radiotherapy is enough, 4 times of chemotherapy in total (2 times before radiotherapy, 2 times after radiotherapy)