Controversies in the Management of Endometrial Cancer (original) (raw)
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Endometrial Cancer: Screening, Diagnosis, and Surgical Staging
2016
Through case studies, the authors point out environmental and hereditary factors that contribute to increased risk of developing endometrial cancer and how to apply screening modalities in pre- and postmenopausal women. Attention is drawn to certain anatomic abnormalities that prevent vaginal bleeding - the most common symptom related to cancer. Diagnostic tests that are available to pursue various aspects of the diagnosis in a sequential fashion are described, culminating in the endometrial biopsy. Recommendations for screening and diagnosis in the asymptomatic as well as the symptomatic patients are summarized. Surgical stag- ing represents the final event in the diagnostic workup. Instances when such staging can be modified to deal with various comorbidities are delineated.
Endometrial adenocarcinoma - presenting pathology is a poor guide to surgical management
The Australian and New Zealand Journal of Obstetrics and Gynaecology, 2000
We aimed to evaluate the correlation between the histological grade of endometrial cancer diagnosed on endometrial biopsy or curettage, with the definitive grade and stage of lesion as determined by surgery and histopathological examination and to make recommendations about the suitability of conservative surgery based on preoperative determination of the grade of endometrial adenocarcinoma. A retrospective review of all patients with endometrii adenocarcinoma presenting to the Queensland Centre for Gynaecological Cancer from 1 January 1996 to 31 December 1998 was undertaken. Clinical and pathological data was abstracted h m medical records and case notes of 460 patients. All histological specimens were prospectively reviewed by a panel consisting of gynaecologic pathologists, &ynaecologic oncologists and other doctors involved in the treatment of patients with gynaecological malignancies. The percentage of patients whose management would have been optimised by firll surgical staging at the time of initial surgery was calculated. Only 60%. ?1%, and 84% of the patients with a presenting diagnosis of grade 1, 2 and 3 endometrial adenocarcinomas respectively had this confirmed on final histopatholow. Furthermore, using established criteria, 30%, 46% and 100% of patients presenting with grade 1, 2 and 3 endometrial adenocarcinoma required full surgical staging at the time of their primary surgery There is poor correlation between the pre-operative grade of endometrial cancer and the grade as determined on analysis of the resected uterus. The correlation is poorest with grade 1 endometrial adenocarcinoma, where strongest consideration is given to conservative surgery and the avoidance of subspecialty referral. There is a strong argument that all patients with a diagnosis of endometrial cancer made on endometrial biopsy or curettage, regardless of grade of malignancy, should be offered surgery where the option to perform concurrent comprehensive surgical staging is available.
Current Issues in the Management of Endometrial Cancer
Mayo Clinic Proceedings, 2008
Endometrial cancer (EC) remains the most common gynecologic malignancy in the United States. It is expected to become more common as the prevalence of obesity, one of the most common risk factors for EC, increases worldwide. The 2 main histologic subcategories of EC, endometrioid and nonendometrioid EC, show unique molecular aberrations and are responsible for markedly disparate clinical behaviors. The primary treatment of EC is surgery, ie, hysterectomy, removal of the adnexa, and pelvic and para-aortic lymphadenectomy, either via laparotomy or endoscopic techniques. Adjuvant therapy is necessary for patients at high risk of recurrence and consists of vaginal brachytherapy, teletherapy, systemic chemotherapy, or some combination thereof. Multi-institutional trials are in progress in this country and in Europe to better define optimal adjuvant treatment for subsets of patients, as well as the role of surgical staging in reducing both overuse and underuse of radiation therapy. Hormonal therapy is an option for some young women with EC who wish to preserve fertility. This review summarizes the diagnosis and management of EC and discusses current controversies and upcoming investigations pertaining to EC staging and adjuvant treatment.
Endometrial cancer: Pathophysiology, diagnosis and management
IP International Journal of Comprehensive and Advanced Pharmacology
The most prevalent gynecologic disease is cancer of the endometrium, In the US, it is the fourth most prevalent malignancy in women after breast, lung, and colorectal malignancies. Despite a steady prevalence of sickness, during the past 20 years, the death rate has climbed by more than 100%. The risk factors of endometrial cancer includes unopposed estrogen therapy, early menarche, late menopause, tamoxifen therapy, nulliparity, infertility or inability to ovulate, and polycystic ovarian syndrome. Ageing, obesity, hypertension, diabetes mellitus, and genetic nonpolyposis colorectal cancer are additional risk factors. This article presents an overview of endometrial carcinoma's epidemiology, prevention, diagnosis, therapy, and prognosis. Chemotherapy, radiation, surgery, and radiation therapy are all forms of treatment. Nonsurgical treatments can be used to treat endometrial hyperplasia with a low to moderate risk. The likelihood of survival is often determined by the disease st...
ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: Diagnosis, Treatment and Follow-up
International Journal of Gynecologic Cancer, 2016
The first joint European Society for Medical Oncology (ESMO), European SocieTy for Radiotherapy & Oncology (ESTRO) and European Society of Gynaecological Oncology (ESGO) consensus conference on endometrial cancer was held on 11–13 December 2014 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of endometrial cancer. Before the conference, the expert panel prepared three clinically-relevant questions about endometrial cancer relating to the following four areas: prevention and screening, surgery, adjuvant treatment and advanced and recurrent disease. All relevant scientific literature, as identified by the experts, was reviewed in advance. During the consensus conference, the panel developed recommendations for each specific question and a consensus was reached. Results of this consensus conference, together with a summary of evidence supporting each recommendation, are detailed in this article. All participants have approved this final ...
Epidemiology and investigations for suspected endometrial cancer
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2013
To review the evidence relating to the epidemiology of endometrial cancer and its diagnostic workups. Women with possible endometrial cancer can undergo an endometrial evaluation by office biopsy, hysteroscopy, or dilatation and curettage. To assist in treatment planning, pelvic ultrasound, CT scan, or MRI may be considered. The identification of optimal diagnostic tests to evaluate patients with possible endometrial cancer. Published literature was retrieved through searches of PubMed, CINAHL, and The Cochrane Library, using appropriate controlled vocabulary (e.g., endometrial neoplasms) and key words (e.g., endometrium cancer, endometrial carcinoma). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to December 31, 2011. Grey (unpublished) literature was identified through searching the...
American Journal of Obstetrics and Gynecology, 2003
The purpose of this study was to evaluate postmenopausal bleeding and transvaginal sonographic measurement of endometrial thickness as predictors of endometrial cancer and atypical hyperplasia in women whose cases were followed for Ն10 years after referral for postmenopausal bleeding. STUDY DESIGN: Women (n = 394) who had postmenopausal bleeding from November 1987 to October 1990 underwent transvaginal sonographic measurement of endometrial thickness and curettage. It was possible to assess the medical records (regarding recurrence of a postmenopausal bleeding, development of endometrial cancer, and death) in 339 of the 394 women (86%) Ն10 years after referral for postmenopausal bleeding. RESULTS: Thirty-nine of the 339 women (11.5%) had endometrial cancer, and 5 women (1.5%) had atypical hyperplasia. The relative risk of endometrial cancer in women who were referred for postmenopausal bleeding was 63.9 (95% CI, 46.0-88.8); the corresponding relative risk for endometrial cancer and atypical hyperplasia together was 72.1 (95% CI, 52.8-98.5) compared with women of the same age from the general population of the same region of Sweden. No woman with an endometrial thickness of Յ4 mm was diagnosed as having endometrial cancer. The relative risk of the development of endometrial cancer in women with an endometrial thickness of >4 mm was 44.5 (95% CI, 6.5-320.1) compared with women with an endometrial thickness of Յ4 mm. The reliability of endometrial thickness (cutoff value, Յ4 mm) as a diagnostic test for endometrial cancer was assessed: sensitivity, 100%; specificity, 60%; positive predictive value, 25%; and negative predictive value, 100%. The incidence of endometrial cancer or atypical hyperplasia in women with an intact uterus whose cases had been followed for Ն10 years was 5.8% (15/257 women) compared with 22.7% (15/66 women) in women who had Յ1 episode of recurrent bleeding. No endometrial cancer was diagnosed in women with a recurrent postmenopausal bleeding who had an endometrial thickness of Յ4 mm at the initial scan. CONCLUSION: Postmenopausal bleeding incurs a 64-fold increase risk for endometrial cancer. There was no increased risk of endometrial cancer or atypia in women who did not have recurrent bleeding, whereas women with recurrent bleeding were a high-risk group. No endometrial cancer was missed when endometrial thickness measurement (cutoff value, Յ4 mm) was used, even if the women were followed up for Յ10 years. We conclude that transvaginal sonographic scanning is an excellent tool for the determination of whether further investigation with curettage or some form of endometrial biopsy is necessary (Am J Obstet Gynecol 2003;188:401-8.)
Management of Patients Diagnosed with Endometrial Cancer: Comparison of Guidelines
Cancers
Endometrial cancer is the most common gynecological malignancy in Europe and its management involves a variety of health professionals. In recent years, big discoveries were made concerning the management of patients diagnosed with endometrial cancer, particularly in the field of molecular biology and minimally invasive surgery. This requires the continuous updating of guidelines and protocols over the years. In this paper, we aim to summarize and compare common points and disparities among protocols for management of patients diagnosed with endometrial cancer by leading international gynecological oncological societies. We therefore systematically report the parallel among the guidelines based on the various steps patients with endometrial cancer usually undergo. The comparison between American and European protocols revealed some relevant disparities, in particular regarding surgical staging, molecular biology application as a prognostic tool and follow up regimens. This could pos...