Endometrial cancer

Treatment of Endometrial cancer  generally consists of

laparoscopic or open staging procedure including pelvic washings, extrafascial total hysterectomy, bilateral salpingo-oophorectomy, and sometimes omentectomy. Pelvic and para-aortic lymphadenectomy is considered both diagnostic and therapeutic and should be performed in all patients. Intraoperative evaluation of the uterus should be performed by bivalving the uterus and obtaining a frozen section as needed. Adjuvant radiotherapy and/or chemotherapy is used postoperatively in patients with poor prognostic factors who are at high risk for recurrence. Hormonal therapy or chemotherapy is used for advanced disease, but response to chemotherapy has been poor.

TABLE 36-3 Endometrial Cancer Staging
TNM FIGO Definition
T1 I Tumor confined to the corpus uteri
T1a IA Tumor limited to the endometrium
T1b IB Tumor invades less than or up to half of the myometrium
T1c IC Tumor invades more than half of the myometrium
T2 II Tumor invades the cervix but does not extend beyond the uterus
T2a IIA Endocervical glandular involvement only
T2b IIB Cervical stromal invasion
T3 III Local and/or regional spread as specified
T3a IIIA Tumor involves the serosa and/or adnexa and/or positive washings
T3b IIIB Vaginal involvement
N1 IIIC Metastasis to the pelvic and/or para-aortic lymph nodes
T4 IVA Tumor invades the bladder mucosa or the rectum and/or bowel mucosa
M1 IVB Distant metastasis including intra-abdominal and/or inguinal lymph nodes
FIGO, International Federation of Gynecology and Obstetrics; TNM, tumor, node, metastasis.

Prognosis of Endometrial cancer generally is favorable,

with 5-year survival greater than 90% for patients with surgical stage I tumors (Table 36-3). Prognosis depends on the grade of tumor as well as the depth of myometrial invasion, adnexal involvement, pelvic cytology, lymph vascular space invasion, and lymph node spread. Rarer histologies, such as clear-cell or papillary serous cancers and the sarcomas arising from the wall of the uterus, do not share the overall good prognosis of early-stage adenocarcinomas. African American women have mortality rates nearly twice that of white women.