Endometrial cancer surgery: Difference between revisions
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*Myometrial invasion >50% | *Myometrial invasion >50% | ||
*Large tumor ,i.e >2cm in diameter. | *Large tumor ,i.e >2cm in diameter. | ||
===Pelvic lymph node dissection=== | |||
Removal of nodes from distal half of each of common iliac artery, proximal half of external iliac artery and vein and distal half of obturator fat pad. | |||
===Para-aortic lymph node dissection=== | |||
Removal of nodes from distal inferior vena cava. | |||
The primary treatment is surgical. Surgical treatment should consist of, at least, cytologic sampling of the peritoneal fluid, abdominal exploration, palpation and biopsy of suspicious lymph nodes, abdominal [[hysterectomy]], and removal of both [[ovary|ovaries]] (bilateral salpingo-oophorectomy). Lymphadenectomy, or removal of pelvic and para-aortic lymph nodes, is sometimes performed for tumors that have high risk features, such as pathologic grade 3 serous or clear-cell tumors, invasion of more than 1/2 the myometrium, or extension to the cervix or adnexa. Sometimes, removal of the [[omentum]] is also performed. | The primary treatment is surgical. Surgical treatment should consist of, at least, cytologic sampling of the peritoneal fluid, abdominal exploration, palpation and biopsy of suspicious lymph nodes, abdominal [[hysterectomy]], and removal of both [[ovary|ovaries]] (bilateral salpingo-oophorectomy). Lymphadenectomy, or removal of pelvic and para-aortic lymph nodes, is sometimes performed for tumors that have high risk features, such as pathologic grade 3 serous or clear-cell tumors, invasion of more than 1/2 the myometrium, or extension to the cervix or adnexa. Sometimes, removal of the [[omentum]] is also performed. | ||
[[Hysterectomy|Abdominal hysterectomy]] is recommended over [[Hysterectomy|vaginal hysterectomy]] because it affords the opportunity to examine and obtain washings of the abdominal cavity to detect any further evidence of cancer. | [[Hysterectomy|Abdominal hysterectomy]] is recommended over [[Hysterectomy|vaginal hysterectomy]] because it affords the opportunity to examine and obtain washings of the abdominal cavity to detect any further evidence of cancer. | ||
===Radiation therapy=== | ===Radiation therapy=== | ||
Women with stage 1 disease who are at increased risk for recurrence and those with stage 2 disease are often offered surgery in combination with [[radiation therapy]]. | Women with stage 1 disease who are at increased risk for recurrence and those with stage 2 disease are often offered surgery in combination with [[radiation therapy]]. | ||
Revision as of 21:58, 23 September 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Surgery
Preoperative evaluation should include a complete medical history and physical examination, pelvic examination and rectal examination with stool guaiac test, chest X-ray, complete blood count, and blood chemistry tests, including liver function tests.
Total extrafascial hysterectomy with bilateral salpingo-oopherectomy with pelvic or para-aortic lymph node dissection is standard procedure. Complete removal of omentum is warranted for serous or clear cell variety. If a surgeon happens to palpate and find enlarged pelvic or para-aortic lymph nodes, then their sampling or removal is required.
In the operating room, the dissected uterine specimen must be grossly visualized to look for myometrial invasion. In multicenter series of 403 patients who underwent TAH-BSO, the sensitivity , specificity, positive and negative predictive value of gross assessment of myometrial invasion was found to be 73, 93, 85 and 86% respectively. Frozen section of area of invasion is a good practice but it has not shown consistent results.
When to resect lymph nodes?
If the following are present-
- Serous, clear cell or high grade tumor.
- Myometrial invasion >50%
- Large tumor ,i.e >2cm in diameter.
Pelvic lymph node dissection
Removal of nodes from distal half of each of common iliac artery, proximal half of external iliac artery and vein and distal half of obturator fat pad.
Para-aortic lymph node dissection
Removal of nodes from distal inferior vena cava.
The primary treatment is surgical. Surgical treatment should consist of, at least, cytologic sampling of the peritoneal fluid, abdominal exploration, palpation and biopsy of suspicious lymph nodes, abdominal hysterectomy, and removal of both ovaries (bilateral salpingo-oophorectomy). Lymphadenectomy, or removal of pelvic and para-aortic lymph nodes, is sometimes performed for tumors that have high risk features, such as pathologic grade 3 serous or clear-cell tumors, invasion of more than 1/2 the myometrium, or extension to the cervix or adnexa. Sometimes, removal of the omentum is also performed.
Abdominal hysterectomy is recommended over vaginal hysterectomy because it affords the opportunity to examine and obtain washings of the abdominal cavity to detect any further evidence of cancer.
Radiation therapy
Women with stage 1 disease who are at increased risk for recurrence and those with stage 2 disease are often offered surgery in combination with radiation therapy.