Endometrial cancer medical therapy: Difference between revisions

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{{Endometrial cancer}}
{{Endometrial cancer}}
{{CMG}}
{{CMG}} {{AE}}{{RAK}}


==Overview==
==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.
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==
==Medical Therapy==
* 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.
* Chemotherapy is not the first-line treatment option for patients with stage I-III endometrial cancer. Surgery is the mainstay of treatment.


{| class="wikitable"
* Chemotherapy without prior surgery is usually reserved for patients with stage IV endometrial cancer or patients that are not surgical candidates.
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Risk
** Typically a platinum based combination regimen or triple druge therapy is used:<ref name="pmid17617530">{{cite journal| author=Fleming GF| title=Systemic chemotherapy for uterine carcinoma: metastatic and adjuvant. | journal=J Clin Oncol | year= 2007 | volume= 25 | issue= 20 | pages= 2983-90 | pmid=17617530 | doi=10.1200/JCO.2007.10.8431 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17617530  }} </ref>
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Risk definition
*** [[Carboplatin]] + [[paclitaxel]]
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Management
*** [[Cisplatin]] + [[doxorubicin]] + [[paclitaxel]]
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Additional notes
** Endocrine therapy is also used with favorable results in patients with:<ref name="pmid17442022">{{cite journal| author=Decruze SB, Green JA| title=Hormone therapy in advanced and recurrent endometrial cancer: a systematic review. | journal=Int J Gynecol Cancer | year= 2007 | volume= 17 | issue= 5 | pages= 964-78 | pmid=17442022 | doi=10.1111/j.1525-1438.2007.00897.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17442022  }} </ref>
|-
*** [[Endometroid]] endmetrial cancer
| style="background:#DCDCDC;" align="center" + |Low risk
*** Express [[estrogen]] and [[progesterone]] receptors
| style="background:#F5F5F5;" align="center" + |• Stage IA endometrial cancer <br> • Well differentiated endometroid histology <br> • Tumor confined to endometrium
*** Asymptomatic disease
| style="background:#F5F5F5;" align="center" + |Total hysterectomy, bilateral salpingo-oophorectomy, and lymph node evaluation
| style="background:#F5F5F5;" align="center" + |• Women that opt for preservation of fertility may be candidates for medical therapy <br> • Adjuvant therapy not indicated
|-
| style="background:#DCDCDC;" align="center" + |Intermediate risk
| style="background:#F5F5F5;" align="center" + |• Stage I (tumor invades myometrium) or <br> • Stage II (tumor demonstrates cervical stroma invasion) <br> • Tumor usually moderately differentiated or poorly differentiated
| style="background:#F5F5F5;" align="center" + |• Total hysterectomy, bilateral salpingo-oophorecomy, and lymph node evaluation <br> • Adjuvant radiotherapy is indicated for patients with risk factors
| style="background:#F5F5F5;" align="center" + |• No data available to recommend adjuvant chemotherapy in these patients <br> • Observation recommended instead of adjuvant radiotherapy if patient has no risk factors
|-
| style="background:#DCDCDC;" align="center" + |High risk
| style="background:#F5F5F5;" align="center" + |• Stage III or higher  or <br> • Any stage with serous or clear cell carcinoma
| style="background:#F5F5F5;" align="center" + |• For stage I and II, surgery may be followed by adjuvant vaginal brachytherapy <br> • For stage III and IV, surgery should be followed by adjuvant chemotherapy and pelvic radiotherapy
| style="background:#F5F5F5;" align="center" + |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==
==References==

Latest revision as of 16:38, 29 November 2018

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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

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

  • 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.
  • Chemotherapy is not the first-line treatment option for patients with stage I-III endometrial cancer. Surgery is the mainstay of treatment.
  • Chemotherapy without prior surgery is usually reserved for patients with stage IV endometrial cancer or patients that are not surgical candidates.

References

  1. Fleming GF (2007). "Systemic chemotherapy for uterine carcinoma: metastatic and adjuvant". J Clin Oncol. 25 (20): 2983–90. doi:10.1200/JCO.2007.10.8431. PMID 17617530.
  2. Decruze SB, Green JA (2007). "Hormone therapy in advanced and recurrent endometrial cancer: a systematic review". Int J Gynecol Cancer. 17 (5): 964–78. doi:10.1111/j.1525-1438.2007.00897.x. PMID 17442022.


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