ReviewEndometrial cancer: A review and current management strategies: Part II
Introduction
Endometrial carcinoma is the most common gynecologic malignancy and will be encountered by almost every gynecologist. A thorough understanding of the epidemiology, pathophysiology, and management strategies for endometrial carcinoma allows the obstetrician–gynecologist to identify women at increased risk, contribute toward risk reduction, and facilitate early diagnosis of this cancer. The purpose of this document is to continue a review of the risks and benefits of current treatment options and optimize treatment for women with endometrial cancer.
Section snippets
Adjuvant therapy
Selecting appropriate adjuvant therapy for patients with early-stage endometrial cancer is difficult. To date, no level I evidence supports adjuvant therapy of any form in patients with early-stage endometrial cancer when the endpoint is overall 5-year survival. Further complicating the decision process is the fact that “early-stage” endometrial cancer actually comprises two types of patients: those who are comprehensively staged and have received appropriate nodal evaluation and those who are
Therapy for advanced stage disease
Advanced-stage endometrial cancer is a heterogeneous disease that may present as pulmonary metastasis, micro- or macroscopic lymph node metastasis, intra-abdominal metastasis, or distant inoperable metastasis. Most investigators consider patients with these different presentations as one group, despite their very different prognoses. Therefore, defining an optimal treatment regimen is difficult.
Do women with synchronous endometrial and ovarian cancers have worse prognoses?
Women with synchronous tumors of the endometrium and ovary are generally younger than those with either endometrial or ovarian adenocarcinomas. Synchronous tumors tend to be low grade and are often found at an early stage. Synchronous endometrioid tumors are frequently associated with endometriosis and have a better prognosis than other histologic types of carcinoma [39]. A population-based study in the Netherlands sought to identify histologic pathways in the synchronous occurrence [40]. A new
Fertility-sparing treatments for endometrial cancer
Up to 30% of patients diagnosed with endometrial cancer are younger than 54 years of age. Approximately 9% of women diagnosed with the disease are younger than age of 44, and 20% are between 45 and 54 years of age [44], [45]. Although the common assumption would be that these women would have early-stage, low-grade malignancies, this may not be the case. In a population-based registry (Geneva Cancer Registry), 44 (3.2%) of women with endometrial cancer were 45 years and younger, and only 8 (18%)
Should surgical staging be completed in all patients who have an incidental diagnosis of endometrial cancer following hysterectomy for another indication?
The need for repeat surgery for the sole purpose of staging in women discovered to have endometrial cancer following hysterectomy needs to be considered carefully. A dedicated study will probably never be performed because of relative rarity of the situation. Comprehensive pathology review is mandatory to retrieve as much information as possible about the uterine features of the cancer. These features include histologic cell type, nuclear and FIGO grade, depth of myometrial invasion, presence
Can radiotherapy be used as a primary treatment modality for endometrial cancer?
In patients who cannot undergo hysterectomy or surgical staging following an endometrial cancer diagnosis, primary radiation therapy remains a viable option for locoregional disease control. Several studies have evaluated this special circumstance. The 5-year OS following primary radiation therapy ranges from 39% to 71% [64], [65], [66].
How can clinicians optimize the outcome of primary radiation therapy for endometrial cancer?
Advances in modern imaging techniques, such as CT, MRI or PET/CT scan to assess for extrauterine disease, may improve the outcomes of women by allowing
What is the appropriate follow-up for women after treatment of endometrial cancer?
The aim of surveillance following treatment of endometrial cancer is detection of treatable recurrent disease, thereby enabling cure or improved survival. Unfortunately, the role of surveillance in endometrial cancer has not been evaluated in any prospective trial. Given that most endometrial cancers are early stage when initially diagnosed and treated and that recurrence is often local and curable, a cost-effective surveillance strategy is desirable. A recent review of post-treatment
Does hormone replacement therapy increase the risk of developing endometrial carcinoma?
The use of long-cycle estrogen and progestin hormone replacement therapy (HRT) showed a tendency toward an elevated risk of developing endometrial carcinoma both for exposure of less than 5 years (hazard ratio [HR] 1.40; CI 0.82–2.38) and for estimated use of 5 years or more (HR 1.63; CI 1.12–2.38) [69]. For an estimated exposure of more than 10 years, the risk for endometrial cancer was elevated among both users of long-cycle HRT (HR 2.95; CI 2.40–3.62) and sequential HRT (HR 1.38; CI 1.15–1.66).
Conflict of interest statement
Mario M. Leitao, Jr, MD is a consultant for Intuitive Surgical. Thomas J. Herzog is a consultant for Merck, Morphotek, and Genentech. All other authors declare no conflicts of interest.
Acknowledgments
Manuscript editing was funded by the Society of Gynecologic Oncology (SGO).
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