Treatment

Consult expert advice.

Treatment options for endometrial cancer include:

• surgical treatment - comprises total abdominal hysterectomy, bilateral salpingo-oophorectomy, and peritoneal washings. In some, pelvic and para-aortic lymphadenectomy and omentectomy may be performed. Surgery can be carried out via laparotomy (entry via a transverse or midline incision), or laparoscopy
  • stage I – standard approach consists of a total abdominal hysterectomy and bilateral salpingo-oophorectomy with or without lymphadenectomy
    • in the UK, pelvic lymphadenectomy is not routinely performed alongside total abdominal hysterectomy and bilateral salpingo-oophorectomy, however in the US, pelvic lymphadenectomy is routinely performed in patients with stage I disease
  • stage II - managed with an extended or modified radical hysterectomy, bilateral salpingo-oopherectomy, and systematic pelvic lymphadenectomy with or without para-aortic lymphadenectomy. Lymphadenectomy is used as a guide for surgical staging and adjuvant therapy
  • stage III-IV - maximal surgical debulking is recommended in this groups. Palliative surgery could be considered for distant metastasis
• radiotherapy
  • used in the adjuvant setting
  • radiotherapy can be delivered as external beam radiotherapy or vaginal brachtherapy
• chemotherapy
  • used in the adjuvant setting
  • includes carboplatin, doxorubicin, taxol
  • progestins are not used in the adjuvant treatment of endometrial cancer (1,2)

Reference:

• (1) Saso S et al. Endometrial cancer. BMJ. 2011;343:d3954
• (2) Colombo N et al. Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24 Suppl 6:vi33-8