Endometrial cancer surgery: Difference between revisions

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__NOTOC__
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{{Endometrial cancer}}
{{Endometrial cancer}}
{{CMG}}; '''Associate Editor(s)-in-Chief:''' [[User: Shankar Kumar |Shankar Kumar, M.B.B.S.]] [mailto:kumarshankar@wikidoc.org]]
{{CMG}}{{AE}}{{RAK}}
==Overview==
Surgery is the mainstay of treatment for endometrial cancer stage I-III.


==Overview==
==Surgery==
==Surgery==
 
*Surgery is the first-line treatment option for patients with endometrial cancer especially if no [[metastasis]] is suspected.
 
*The treatment approach is based on staging, [[pathology]], and [[Histology|histologic]] features of the cancer:<ref name="pmid1555983">{{cite journal| author=Grigsby PW, Perez CA, Kuten A, Simpson JR, Garcia DM, Camel HM et al.| title=Clinical stage I endometrial cancer: prognostic factors for local control and distant metastasis and implications of the new FIGO surgical staging system. | journal=Int J Radiat Oncol Biol Phys | year= 1992 | volume= 22 | issue= 5 | pages= 905-11 | pmid=1555983 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1555983  }} </ref><ref name="pmid10546716">{{cite journal| author=Connell PP, Rotmensch J, Waggoner SE, Mundt AJ| title=Race and clinical outcome in endometrial carcinoma. | journal=Obstet Gynecol | year= 1999 | volume= 94 | issue= 5 Pt 1 | pages= 713-20 | pmid=10546716 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10546716  }} </ref>
 
{| class="wikitable"
:Stage I Endometrial Cancer
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Risk
Standard treatment options:
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Risk definition
A total hysterectomy and bilateral salpingo-oophorectomy should be done if the tumor:
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Management
 
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Additional notes
Is well or moderately differentiated.
|-
Involves the upper 66% of the corpus.
| style="background:#DCDCDC;" align="center" + |Low risk
Has negative peritoneal cytology.
| style="background:#F5F5F5;" align="center" + |• Stage IA endometrial cancer <br> • Well [[Cellular differentiation|differentiated]] [[endometroid]] histology <br> • Tumor confined to [[endometrium]]
Is without vascular space invasion.
| style="background:#F5F5F5;" align="center" + |Total [[hysterectomy]], bilateral [[salpingo-oophorectomy]], and lymph node evaluation
Has less than a 50% myometrial invasion.
| style="background:#F5F5F5;" align="center" + |• Women that opt for preservation of fertility may be candidates for medical therapy <br> • [[Adjuvant therapy]] not indicated
 
|-
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.
| 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
Stage II Endometrial Cancer
| 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
Standard treatment options:
|-
If cervical involvement is documented, options include radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic and para-aortic lymph node dissection.
| style="background:#DCDCDC;" align="center" + |High risk
If the cervix is clinically uninvolved but extension to the cervix is documented on postoperative pathology, radiation therapy should be considered.
| style="background:#F5F5F5;" align="center" + |• Stage III or higher or <br> • Any stage with serous or clear cell carcinoma
Current Clinical Trials
| 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
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).
| style="background:#F5F5F5;" align="center" + |Giving adjuvant brachytherapy for the high risk early staged tumors depends on patient and provider preferences
 
|}
Stage III Endometrial Cancer  
stage III endometrial cancer 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.
 
==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]].


==References==
==References==
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Latest revision as of 16:40, 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

Surgery is the mainstay of treatment for endometrial cancer stage I-III.

Surgery

  • Surgery is the first-line treatment option for patients with endometrial cancer especially if no metastasis is suspected.
  • The treatment approach is based on staging, pathology, and histologic features of the cancer:[1][2]
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

References

  1. ↑ Grigsby PW, Perez CA, Kuten A, Simpson JR, Garcia DM, Camel HM; et al. (1992). "Clinical stage I endometrial cancer: prognostic factors for local control and distant metastasis and implications of the new FIGO surgical staging system". Int J Radiat Oncol Biol Phys. 22 (5): 905–11. PMID 1555983.
  2. ↑ Connell PP, Rotmensch J, Waggoner SE, Mundt AJ (1999). "Race and clinical outcome in endometrial carcinoma". Obstet Gynecol. 94 (5 Pt 1): 713–20. PMID 10546716.


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