Endometrial cancer surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Roukoz A. Karam, M.D.[2]
Overview
Surgery is the mainstay of treatment for endometrial cancer stage I-III.
Surgery
- Surgery is the first-line treatment option for patients with endometrial cancer especially if no metastasis is suspected.
- The treatment approach is based on staging, pathology, and histologic features of the cancer:[1][2]
| Risk | Risk definition | Management | Additional notes |
|---|---|---|---|
| Low risk | • Stage IA endometrial cancer • Well differentiated endometroid histology • Tumor confined to endometrium |
Total hysterectomy, bilateral salpingo-oophorectomy, and lymph node evaluation | • Women that opt for preservation of fertility may be candidates for medical therapy • Adjuvant therapy not indicated |
| Intermediate risk | • Stage I (tumor invades myometrium) or • Stage II (tumor demonstrates cervical stroma invasion) • Tumor usually moderately differentiated or poorly differentiated |
• Total hysterectomy, bilateral salpingo-oophorecomy, and lymph node evaluation • Adjuvant radiotherapy is indicated for patients with risk factors |
• No data available to recommend adjuvant chemotherapy in these patients • Observation recommended instead of adjuvant radiotherapy if patient has no risk factors |
| High risk | • Stage III or higher or • Any stage with serous or clear cell carcinoma |
• For stage I and II, surgery may be followed by adjuvant vaginal brachytherapy • For stage III and IV, surgery should be followed by adjuvant chemotherapy and pelvic radiotherapy |
Giving adjuvant brachytherapy for the high risk early staged tumors depends on patient and provider preferences |
References
- ↑ Grigsby PW, Perez CA, Kuten A, Simpson JR, Garcia DM, Camel HM; et al. (1992). "Clinical stage I endometrial cancer: prognostic factors for local control and distant metastasis and implications of the new FIGO surgical staging system". Int J Radiat Oncol Biol Phys. 22 (5): 905–11. PMID 1555983.
- ↑ Connell PP, Rotmensch J, Waggoner SE, Mundt AJ (1999). "Race and clinical outcome in endometrial carcinoma". Obstet Gynecol. 94 (5 Pt 1): 713–20. PMID 10546716.