Endometrial Cancer: Advanced Stage
For patients with stage III/IV endometrial carcinoma, prognosis remains poor and an optimum therapy is yet to be established. Treatment is individualized based on disease extent at presentation, patient’s performance status, and hormonal status of the tum
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Endometrial Cancer: Advanced Stage Rama Joshi
Abstract
For patients with stage III/IV endometrial carcinoma, prognosis remains poor and an optimum therapy is yet to be established. Treatment is individualized based on disease extent at presentation, patient’s performance status, and hormonal status of the tumor. Surgery is often the mainstay of treatment in stage III disease. The role of adjuvant radiotherapy in conferring survival is controversial. Chemotherapy is fast emerging as an effective adjuvant treatment for advanced endometrial cancer. Hormonal therapy with variable response rates has been used for metastatic and recurrent endometrial carcinoma. The GOG continues to investigate multimodality therapy.
Endometrial carcinoma is the most common malignancy of the female genital tract in the western world and the fourth most common cancer in the women after breast, lung, and colorectal cancer. Developing countries and Japan have incidence rates 4–5 times lower than western industrialized nations with the lowest rates being in India and South Asia [1]. In 2/3 cases of endometrial cancer, the tumor is confined to the corpus at the time of diagnosis where uncorrected survival rates of 75 % or more are expected [2]. In patients of advanced endometrial cancer with documented extrauterine disease of stage III or IV, the prognosis remains poor.
R. Joshi, MBBS, MS Department of Gynae Oncology, Fortis Memorial Research Institute, Gurgaon, India e-mail: [email protected] © Springer Nature Singapore Pte Ltd. 2017 R. Patni (ed.), Current Concepts in Endometrial Cancer, DOI 10.1007/978-981-10-3108-3_8
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In the past 50 years, the treatment of endometrial cancer has evolved from a regime of preoperative intracavitary radium packing or external pelvic radiation therapy (RT) followed in 6 weeks by hysterectomy to customized treatment program of primary surgery where hysterectomy with bilateral salpingo-oophorectomy and surgical staging has now become the standard of care management. The adjuvant treatment is employed subject to the stage of the disease and other histological risk factors. The patients of endometrial cancer are staged according to FIGO 2009 (Table 8.1) [3]. In the past 30 years, the role of chemotherapy has emerged, and various chemotherapeutic regimes have been tried and tested as the adjuvant treatment in primary setting.
Diagnosis and Staging Studies The diagnosis of endometrial cancer is confirmed by the histopathology of endometrial curettage/endometrial biopsy. Thorough evaluation of patient, including complete physical examination, and metastatic workup can define the extrauterine spread of the disease within the pelvis or outside the pelvis, in the abdomen, and in supraclavicular or inguinal nodal areas. These patients often have comorbid conditions of obesity, diabetes, and hypertension which require to be evaluated prior to the treatment decision of the disease. The workup includes imaging ultrasonography (USG), magnetic resonance imaging (MRI), CA125, and PET–CT when indic
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