Endometrial cancer surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Monalisa Dmello, M.B,B.S., M.D. [2]

Surgery

Stage I endometrial Cancer

• Standard treatment options:

• A total hysterectomy and bilateral salpingo-oophorectomy should be done if the tumor:

• Is well or moderately differentiated.
• Involves the upper 66% of the corpus.
• Has negative peritoneal cytology.
• Is without vascular space invasion.
• Has less than a 50% myometrial invasion.

Selected pelvic lymph nodes may be removed. If they are negative, no postoperative treatment is indicated. Postoperative treatment with a vaginal cylinder is advocated by some clinicians.

Stage II endometrial Cancer

• Standard treatment options:

• 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.

• Current Clinical Trials

• The completed GOG-LAP2 trial included 2,616 patients with clinical stage I to IIA disease and randomly assigned them two-to-one to comprehensive surgical staging via laparoscopy or laparotomy.The recurrence rate at 3 years was 10.24% for patients in the laparotomy arm, compared with 11.39% for patients in the laparoscopy arm, with an estimated difference between groups of 1.14% (90% lower bound, -1.278; 95% upper bound, 3.996).

Stage III endometrial Cancer

• The patients are treated with surgery, followed by chemotherapy, or radiation therapy, or both.

Stage IV endometrial cancer

• When possible, patients with stage IV endometrial cancer are treated with surgery, followed by chemotherapy, or radiation therapy, or both.

References

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