eMedicine Specialties > Obstetrics and Gynecology > Gynecologic Oncology

Endometrial Carcinoma: Treatment & Medication

Author: William T Creasman, MD, J Marion Sims Professor, Department of Obstetrics and Gynecology, Medical University of South Carolina
Contributor Information and Disclosures

Updated: Aug 3, 2009

Treatment

Surgical Care

Since 1988, FIGO, whose Gynecologic Oncology Committee was responsible for the staging of gynecological cancer, recommended that corpus cancer be staged surgically. Previously, clinical evaluation was used for staging, and multiple studies noted the inaccuracy of clinical staging compared with surgical pathological findings. Therefore, once the diagnosis of endometrial cancer has been made, routine presurgical evaluation is performed to assess operability.

  • Special studies, such as CT scans of the abdomen and pelvis or MRIs, are not routinely performed.
  • Once preoperative evaluation, which may include a chest radiograph, ECG, and appropriate blood studies, has been performed and the results are found to be normal, the patient is deemed a surgical candidate. Then, an exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal cytology, and pelvic and para-aortic lymphadenectomy are performed.
  • Obviously, if intraperitoneal disease is identified at the time of surgery, attempts are made at surgical removal.
  • Staging is then determined based on surgical pathologic findings (see Staging). Subsequent therapy, if needed, is then determined, depending on the surgical pathological findings of the operative procedure.

Medication

The goals of pharmacotherapy are to eradicate the carcinoma, to reduce morbidity, and to prevent complications.

Chemotherapeutic agents

Used in the treatment of endometrial cancer. Inhibit cell growth and proliferation.


Cisplatin (Platinol)

Inhibits DNA synthesis and, thus, cell proliferation by causing DNA crosslinks and denaturation of double helix.

Adult

50-100 mg/m2 IV q3-4wk

Pediatric

Not established

Increases toxicity of bleomycin and ethacrynic acid

Documented hypersensitivity; preexisting renal insufficiency; myelosuppression; hearing impairment; peripheral neuropathy

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Administer adequate hydration before and 24 h after cisplatin dosing to reduce risk of nephrotoxicity; myelosuppression, ototoxicity, nausea, and vomiting may occur

More on Endometrial Carcinoma

Overview: Endometrial Carcinoma
Differential Diagnoses & Workup: Endometrial Carcinoma
Treatment & Medication: Endometrial Carcinoma
Follow-up: Endometrial Carcinoma
References
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References

  1. Surveillance, Epidemiology, and End Results (SEER) Program. SEER Database: Incidence - SEER 9 Regs Public-Use. National Cancer Institute, DCCPS, Surveillance Research Program. Available at http://seer.cancer.gov/.

  2. Bernstein L, Deapen D, Cerhan JR, et al. Tamoxifen therapy for breast cancer and endometrial cancer risk. J Natl Cancer Inst. Oct 6 1999;91(19):1654-62. [Medline].

  3. Creasman WT. Endometrial cancer: incidence, prognostic factors, diagnosis, and treatment. Semin Oncol. Feb 1997;24(1 Suppl 1):S1-140-S1-50. [Medline].

  4. Creasman WT. Revised FIGO staging for carcinoma of the vulva, cervix and endometrium. Inter J Gynecol and Obstet. 2009;105:103-4.

  5. Kilgore LC, Partridge EE, Alvarez RD. Adenocarcinoma of the endometrium: survival comparisons of patients with and without pelvic node sampling. Gynecol Oncol. Jan 1995;56(1):29-33. [Medline].

  6. Chan JK, Cheung MK, Huh WK, et al. Therapeutic role of lymph node resection in endometrioid corpus cancer: a study of 12,333 patients. Cancer. Oct 15 2006;107(8):1823-30. [Medline].

  7. American College of Obstetricians and Gynecologists. Estrogen replacement therapy and endometrial cancer. ACOG Committee Opinion: Committee on Gynecologic Practice Number 126--August 1993. Int J Gynaecol Obstet. Oct 1993;43(1):89. [Medline].

  8. Creasman WT, Kohler MF, Odicino F, et al. Prognosis of papillary serous, clear cell, and grade 3 stage I carcinoma of the endometrium. Gynecol Oncol. Dec 2004;95(3):593-6. [Medline].

  9. Creasman WT, Morrow CP, Bundy BN, et al. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer. Oct 15 1987;60(8 Suppl):2035-41. [Medline].

  10. DiSaia PJ, Creasman WT. 7th ed. Clinical Gynecologic Oncology. St. Louis, Mo: Mosby; 2007.

  11. Ferenczy A, Gelfand M. The biologic significance of cytologic atypia in progestogen-treated endometrial hyperplasia. Am J Obstet Gynecol. Jan 1989;160(1):126-31. [Medline].

  12. Goff BA, Kato D, Schmidt RA, et al. Uterine papillary serous carcinoma: patterns of metastatic spread. Gynecol Oncol. Sep 1994;54(3):264-8. [Medline].

  13. Kadar N, Malfetano JH, Homesley HD. Determinants of survival of surgically staged patients with endometrial carcinoma histologically confined to the uterus: implications for therapy. Obstet Gynecol. Oct 1992;80(4):655-9. [Medline].

  14. Kurman RJ, Kaminski PF, Norris HJ. The behavior of endometrial hyperplasia. A long-term study of "untreated" hyperplasia in 170 patients. Cancer. Jul 15 1985;56(2):403-12. [Medline].

  15. Mariani A, Dowdy SC, Keeney GL, et al. High-risk endometrial cancer subgroups: candidates for target-based adjuvant therapy. Gynecol Oncol. Oct 2004;95(1):120-6. [Medline].

  16. Morrow CP, Bundy BN, Kurman RJ, et al. Relationship between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: a Gynecologic Oncology Group study. Gynecol Oncol. Jan 1991;40(1):55-65. [Medline].

  17. Silverberg SG, Major FJ, Blessing JA, Fetter B, Askin FB, Liao SY, et al. Carcinosarcoma (malignant mixed mesodermal tumor) of the uterus. A Gynecologic Oncology Group pathologic study of 203 cases. Int J Gynecol Pathol. 1990;9(1):1-19. [Medline].

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Further Reading

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Keywords

corpus cancer, cancer, endometrial cancer, endometrium cancer, gynecologic cancer, gynecological cancer, adenocarcinoma, cervix cancer, cervical cancer

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Contributor Information and Disclosures

Author

William T Creasman, MD, J Marion Sims Professor, Department of Obstetrics and Gynecology, Medical University of South Carolina
William T Creasman, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Gynecological and Obstetrical Society, American Medical Association, North Carolina Medical Society, Society of Gynecologist Oncologists, and South Carolina Medical Association
Disclosure: Nothing to disclose.

Medical Editor

John J Kavanagh Jr, MD, Chief, Professor, Department of Internal Medicine, Section of Gynecological and Medical Therapeutics, MD Anderson Cancer Center, University of Texas College of Medicine
John J Kavanagh Jr, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association for the History of Medicine, American College of Physicians, American Federation for Medical Research, American Medical Association, Society of Gynecologist Oncologists, Southern Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

A David Barnes, MD, PhD, MPH, FACOG, Consulting Staff, Department of Obstetrics and Gynecology, Mammoth Hospital, Mammoth Lakes, California, Pioneer Valley Hospital, Salt Lake City, Utah, Warren General Hospital, Warren, Pennsylvania and Mountain West Hospital, Tooele, Utah
A David Barnes, MD, PhD, MPH, FACOG is a member of the following medical societies: American College of Forensic Examiners, American College of Obstetricians and Gynecologists, American Medical Association, Association of Military Surgeons of the US, and Utah Medical Association
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD, Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

 
 
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