Endometrial cancer medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The optimal therapy for endometrial cancer depends on the stage at diagnosis. A combination of chemotherapy and radiation therapy is indicated in stages IIIB- IV.

Medical Therapy

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

Stage I Endometrial Cancer

• A total hysterectomy and bilateral salpingo-oophorectomy should be done.
• Selected pelvic lymph nodes may be removed. If they are negative, no postoperative treatment is indicated.

Stage II Endometrial Cancer

• If cervical involvement is documented, options include radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic and para-aortic lymph node dissection.
• If the cervix is clinically uninvolved but extension to the cervix is documented on postoperative pathology, radiation therapy should be considered.

Stage III Endometrial cancer

• Patients with stage III endometrial cancer are treated with surgery, followed by chemotherapy, or radiation therapy, or both.
• Patients with inoperable disease caused by tumor that extends to the pelvic wall may be treated with a combination of chemotherapy and radiation therapy. The usual approach is to use a combination of intracavitary radiation therapy and external-beam radiation therapy.

Stage IV Endometrial cancer

• Treatment of patients with stage IV endometrial cancer is dictated by the site of metastatic disease and symptoms related to disease sites. For bulky pelvic disease, radiation therapy consisting of a combination of intracavitary and external-beam radiation therapy is used.

References

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