endometrial%20cancer
ENDOMETRIAL CANCER
Treatment Guideline Chart

Endometrial cancer is also known as uterine cancer, cancer of the corpus uteri, uterine corpus cancer, endometrical carcinoma.

It is the 6th most common malignancy worldwide.

Management of endometrial cancer should be divided based on risk, disease stage & patient's desire for fertility.

Surgical Intervention

  • Considered as primary treatment for patients whose disease are confined to the endometrium (endometrioid type, grade 1 or 2)
  • Initial surgical approach should include comprehensive surgical staging and peritoneal cytology
  • Recommended surgical technique depends on the anatomical involvement of the disease and desire for fertility
  • Complete surgical staging involves extrafascial hysterectomy, bilateral salphingo-oophorectomy, pelvic lymphadenectomy and para-aortic lymphadenectomy
    • Surgical staging via open laparotomy is preferred for comprehensive surgical staging in patients with BMI >40
    • Surgical staging via laparoscopy produces lesser post-op adverse effects and higher quality of life during the recovery period compared to laparotomy
    • Extrafascial hysterectomy and bilateral salphingo-oophorectomy (EH-BSO) is the preferred surgical procedure for staging and management of medically operable endometrial carcinoma EH-BSO with cytology of peritoneal lavage, lymphadenectomy, and surgical debulking is recommended especially for patients with intra-abdominal involvement
      • EH-BSO with cytology of peritoneal lavage, lymphadenectomy, and surgical debulking is recommended especially for patients with intra-abdominal involvement 
  • Open, laparoscopic, or vaginal approach may be utilized
    • Vaginal hysterectomy is preferred in women with benign disease or early-stage endometrioid endometrial cancer at high surgical morbidity risk and is an option for low-risk patients not requiring lymph node dissection
    • Minimally-invasive surgical technique eg laparoscopy (traditional and robotic-assisted) is an alternative for patients opposed to open laparotomy and recommended for patients with low to intermediate risk
    • With fewer postoperative adverse events and shorter operative time reported
  • For patients with incomplete surgical staging, imaging is recommended especially for patients with higher grade and deeply invasive disease

Recommended Surgical Technique Based on Cancer Stage:

Stage I Endometrial Cancer

  • TH-BSO with surgical staging and lymph node assessment is recommended
  • Fertility-preserving techniques may be considered
  • Vaginal hysterectomy with salphingo-oophorectomy may be considered in patients with contraindications to open surgery
  • For patients with non-endometrioid type, extrafascial hysterectomy and BSO with lymphadenectomy is recommended
    • Omentectomy + random peritoneal biopsy should also be considered in patients with papillary serous carcinoma

Stage II Endometrial Cancer

  • Radical hysterectomy may be considered
  • TH-BSO or radical hysterectomy with surgical staging and lymph node assessment is recommended 
  • Type A or B (modifed) radical hysterectomy may be used
  • Lymphadenectomy should be done

Stage III-IV Endometrial Cancer

  • TH-BSO, complete cytoreductive surgery and comprehensive staging is recommended for patients whose disease is confined within the abdomen or pelvis
    • Also recommended for non-endometrioid type endometrial cancer 
  • Multidisciplinary methods should be applied in managing advanced endometrial cancer

Salphingectomy

  • Surgical option for patients not willing to undergo or are not candidates for salphingo-oophorectomy
  • Bilateral salphingo-oophorectomy may be excluded in patients <45 years old with grade 1 endometrioid-type endometrial cancer, <50% myometrial invasion and without metastatic disease
  • Not recommended for patients at high risk for ovarian cancer

Lymphadenectomy

  • Used for cancer staging, and serves as a guide for appropriate adjuvant therapy for better survival rates and lesser adverse events
    • Recommended for high-risk patients
    • May be considered in intermediate-risk patients for staging purposes, but not necessary in low-risk patients 
  • Includes dissection of the pelvic and/or para-aortic lymph nodes
  • May serve as a guide for appropriate adjuvant therapy for better survival rates and lesser adverse events
  • Pre-/intra-operative findings that excludes the need for lymphadenectomy:
    • <50% myometrial invasion
    • Tumor size <2 cm
    • Well or moderately differentiated histology 
  • Sentinel lymph node dissection (SLND) may be considered to improve the detection of small metastases and isolated tumor cells in lymph nodes

Cytoreductive Surgery

  • May improve progression-free and overall survival rates in patients with advanced-stage or recurrent disease

Recurrent Endometrial Cancer

  • Surgical resection and/or EBRT, or ablative therapy may be considered in patients with isolated metastases
    • May also consider chemotherapy in patients with high-risk disease
  • Cytoreduction therapy improves survival rate and helps reduce recurrence in patients with intra-abdominal disease
    • Surgery may be considered only if cytoreduction without residual disease is possible
    • Exenteration may be considered in patients with locally advanced disease and those with isolated central local relapse with clear margins post-radiation therapy
Editor's Recommendations