Treatment of endometrial cancer

A. The treatment of endometrial cancer is usually surgical, such as total abdominal hysterectomy, bilateral salpingo-oophorectomy and evaluation for metastatic disease, which may include pelvic or para-aortic lymphadenectomy, peritoneal cytologic examination and peritoneal biopsies. The extent of the surgical procedure is based on the stage of disease, which can be determined only at the time of the operation.

Staging for Carcinoma of the Corpus Uteri

Stage*

Description

IA (G1, G2, G3)

Tumor limited to endometrium

IB (G1, G2, G3)

Invasion of less than one half of the myometrium

IC (G1, G2, G3)

Invasion of more than one half of the myometrium

IIA (G1, G2, G3)

Endocervical gland involvement

IIB (G1, G2, G3)

Cervical stromal involvement

IIIA (G1, G2, G3)

Invasion of serosa and/or adnexa and/or positive peritoneal cytologic results

IIIB (G1, G2, G3)

Metastases to vagina

IIIC (G1, G2, G3)

Metastases to pelvic and/or para-aortic lymph nodes

IVA (G1, G2, G3)

Invasion of bladder and/or bowel mucosa

IVB

Distant metastases including intraabdominal and/or inguinal lymph nodes

*--Carcinoma of the corpus is graded (G) according to the degree of histologic differentiation: G1 = 5 percent or less of a solid growth pattern; G2 = 6 to 50 percent of a solid growth pattern; G3 = more than 50 percent of a solid growth pattern.

B. For most patients whose cancers have progressed beyond stage IB grade 2, postoperative radiation therapy is recommended. Because tumor response to cytotoxic chemotherapy has been poor, chemotherapy is used only for palliation.

C. Endometrial hyperplasia with atypia should be treated with hysterectomy except in extraordinary cases. Progestin treatment is a possibility in women younger than 40 years of age who refuse hysterectomy or who wish to retain their childbearing potential, but an endometrial biopsy should be performed every three months. Treatment of atypical hyperplasia and well-differentiated endometrial cancer with progestins in women younger than 40 years of age results in complete regression of disease in 94 percent and 75 percent, respectively.

D. Patients found to have hyperplasia without atypia should be treated with progestins and have an endometrial biopsy every three to six months.

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