Endometrial Carcinoma Treatment & Management

  • Author: William T Creasman, MD; Chief Editor: Warner K Huh, MD  more...
 
Updated: Sep 08, 2016
 

Approach Considerations

Standard management of endometrial cancer at diagnosis involves surgery, followed by chemotherapy with or without radiation therapy.[1]  In the setting of recurrent disease, secondary cytoreduction has been associated with progression-free (PFS) and overall (OS) survival.[12] Prognostic factors for improved long-term OS were the absence of residual disease following surgical resection and histotype.[12]

Lymph node metastasis is an important concern in patients with high-risk early or advanced endometrial cancer.[13, 14] In evaluating data from 523 French surgical patients over a 12-year period, Bendifallah et al developed a predictive model to identify those at high risk for lymph node metastases using the histopathologic features of histologic grade, tumor diameter, depth of myometrial invasion, and status of lymphovascular space involvement.[13] In a different study, Fotopoulou et al reported that, on the basis of anatomic distribution of positive lymph nodes, when lymphadenectomy is performed for those with high-risk early or advanced disease, the procedure should contain pelvic and para-aortic areas up to the renal vessels to ensure accuracy in the evaluation of all potential positive nodes.[14]

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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.

Note the following:

  • 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.
  • Data extracted from the SEER database indicate that among women younger than 60 years with stage 1B and 1C endometrioid adenocarcinoma who underwent lymphadenectomy were less likely to undergo full pelvic radiation and more likely to receive brachytherapy; furthermore, the extent of lymphadenectomy influenced the receipt of radiotherapy. [15]

A 2012 review found that for early stage primary endometrioid adenocarcinoma of the endometrium, laparoscopy and laparotomy are associated with similar rates of disease-free and overall survival and that laparoscopy is associated with reduced operative morbidity and shorter hospital stays.[16]

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Contributor Information and Disclosures
Author

William T Creasman, MD J Marion Sims Distinguished University Professor, Department of Obstetrics and Gynecology, Medical University of South Carolina College of Medicine

William T Creasman, MD is a member of the following medical societies: North Carolina Medical Society, Society of Gynecologic Oncology, American College of Obstetricians and Gynecologists, American Gynecological and Obstetrical Society, American Medical Association, South Carolina Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Jori S Carter, MD, MS Assistant Professor, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine

Jori S Carter, MD, MS is a member of the following medical societies: Alpha Omega Alpha, American College of Obstetricians and Gynecologists, Society of Gynecologic Oncology, Association of Women Surgeons, International Society for Magnetic Resonance in Medicine, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Chief Editor

Warner K Huh, MD Professor, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Senior Scientist, Comprehensive Cancer Center, University of Alabama School of Medicine

Warner K Huh, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American College of Surgeons, Massachusetts Medical Society, Society of Gynecologic Oncology, American Society of Clinical Oncology

Disclosure: I have received consulting fees for: Merck; THEVAX.

Additional Contributors

John J Kavanagh, Jr, MD Chief, Professor, Department of Internal Medicine, Section of Gynecological and Medical Therapeutics, MD Anderson Cancer Center, University of Texas Medical School at Houston

John J Kavanagh, Jr, MD is a member of the following medical societies: American Association for the Advancement of Science, Society of Gynecologic Oncology, American Association for Cancer Research, American Association for the History of Medicine, American College of Physicians, American Federation for Medical Research, American Medical Association, Southern Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Medscape Drugs & Diseases thanks Tarek Bardawil, MD, Assistant Professor, Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, for assistance with the video contribution to this article.

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Diagnostic hysteroscopy for endometrial cancer. Video courtesy of Tarek Bardawil, MD.
Table. Uterine Sarcomas (Leiomyosarcoma, Endometrial Stromal Sarcoma, and Adenosarcoma)
Primary tumor (T)
TNM FIGO stages Surgical-pathologic findings
TX   Primary tumor cannot be assessed
T0   No evidence of primary tumor
T1 I Tumor confined to uterus
T1a IA Tumor ≤5 cm
T1b IB Tumor >5 cm
T2a IIA Tumor extends to the pelvis, adnexal involvement
T2b IIB Tumor extends to extra-uterine pelvic tissue
T3a IIIA Tumor invades abdominal tissues, one site
T3b IIIB Tumor invades more than one site
T4 IVA Tumor invades bladder and/or rectum
Regional lymph nodes (N)
TNM FIGO stages Surgical-pathologic findings
NX   Regional lymph nodes cannot be assessed
N0   No regional lymph node metastasis
N1 IIIC Metastasis to pelvic and/or para-aortic lymph nodes
Distant metastasis (M)
TNM FIGO stages Surgical-pathologic findings
M0   No distant metastasis
M1 IVB Distant metastasis
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