Endometrial cancer medical therapy
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Risk calculators and risk factors for Endometrial cancer medical therapy |
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.