Endometrial Carcinoma Treatment & Management

Updated: Jun 19, 2018
  • Author: William T Creasman, MD; Chief Editor: Warner K Huh, MD  more...
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Treatment

Approach Considerations

Standard management of endometrial cancer at diagnosis involves surgery, followed by chemotherapy and/or 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]

Two randomized trials by Seagle et al examined the association of lymphadenectomy with overall survival in women with stage I endometrioid and node-negative, stage I to IIIB endometrial cancer. One study reported that performance of pelvic lymphadenectomy was associated with increased survival compared with no lymphadenectomy (5-year survival [95% CI], 91.4% [90.2% to 92.6%] v 87.3% [85.9% to 88.8%]; HR, 0.71 [95% CI, 0.64 to 0.78]; P< .001). This study also reported that the addition of para-aortic lymphadenectomy was associated with increased survival compared with pelvic lymphadenectomy alone (5-year survival [95% CI], 91.0% [89.8% to 92.2%] v 89.8% [88.4% to 91.1%]; HR, 0.85 [95% CI, 0.77 to 0.95]; P = .003). [15] Another study concluded that increased lymph node count is associated with a 1% to 14% decreased risk of death per each additional five lymph nodes removed and a 5% to 20% increased 5-year survival among women with pathologically node-negative endometrioid and serous endometrial cancers. [16]

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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, a total 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. [17]

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. [18]

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