Endometrial cancer Flashcards
Stage I
Confined to the uterine corpus and ovary
IA
Disease limited to the endometrium OR non-aggressive histological type, i.e. low-grade endometroid, with invasion of less than half of myometrium with no or focal lymphovascular space involvement (LVSI) OR good prognosis disease
IA1
Non-aggressive histological type limited to an endometrial polyp OR confined to the endometrium
IA2
Non-aggressive histological types involving less than half of the myometrium with no or focal LVSI
IA3
Low-grade endometrioid carcinomas limited to the uterus and ovary
IB
Non-aggressive histological types with invasion of half or more of the myometrium, and with no or focal LVSI
IC
Aggressive histological typese limited to a polyp or confined to the endometrium
Stage II
Invasion of cervical stroma without extrauterine extension OR with substantial LVSI OR aggressive histological types with myometrial invasion
IIA
Invasion of the cervical stroma of non-aggressive histological types
IIB
Substantial LVSId of non-aggressive histological types
IIC
Aggressive histological typese with any myometrial involvement
Stage III
Local and/or regional spread of the tumor of any histological subtype
IIIA
Invasion of uterine serosa, adnexa, or both by direct extension or metastasis
IIIA1 Spread to ovary or fallopian tube (except when meeting stage IA3 criteria)c
IIIA2 Involvement of uterine subserosa or spread through the uterine serosa
IIIB
Metastasis or direct spread to the vagina and/or to the parametria or pelvic peritoneum
IIIB1 Metastasis or direct spread to the vagina and/or the parametria
IIIB2 Metastasis to the pelvic peritoneum
IIIC
Metastasis to the pelvic or para-aortic lymph nodes or bothf
IIIC1 Metastasis to the pelvic lymph nodes
IIIC1i Micrometastasis
IIIC1ii Macrometastasis
IIIC2 Metastasis to para-aortic lymph nodes up to the renal vessels, with or without metastasis to the pelvic lymph nodes
IIIC2i Micrometastasis
IIIC2ii Macrometastasis
Stage IV
Spread to the bladder mucosa and/or intestinal mucosa and/or distance metastasis
IVA
Invasion of the bladder mucosa and/or the intestinal/bowel mucosa
IVB
Abdominal peritoneal metastasis beyond the pelvis
IVC
Distant metastasis, including metastasis to any extra- or intra-abdominal lymph nodes above the renal vessels, lungs, liver, brain, or bone
Treatment STAGE 1a GRADE-1
Lap TAH+BSO, no adjuvant RT
VAGINAL BRACHYTHERAPY EBRT: for nodes positive with
For patients with high/intermediate risk factors (at least two of the factors:
a. age >60 years,
b. deep myometrial invasion,
c. grade 3,
d. serous or clear cell histology,
e. LVSI,
STAGE 3 AND 4:
staging laparotomy and aim to debulk disease, with systemic lymphadenectomy.
* If both the para-aortic and pelvic nodes are negative use adjuvant vault radiotherapy + EBRT, which reduces
local recurrences
* Patients with clinical Stage III endometrial carcinoma in which surgical resection is not possible are treated
primarily by pelvic irradiation, with or without chemotherapy. Once therapy has been completed, exploratory
laparotomy should be considered for those patients whose disease now appears to be resectable
STAGE 4
Treatment should be individualized to achieve local control. Pulmonary metastases are the most
common site of distant disease.
* A combination of surgery, radiotherapy for palliative local control, and chemotherapy for distant
control can be used.
* NCT :- poor candidates for surgery. Carboplatin+ paclitaxel
* Progestogens have been demonstrated to be useful for pulmonary metastases. (Response rates vary
from 0 to 53%).
* Pelvic radiotherapy in Stage IV disease is sometimes considered to provide local tumor control.
Similarly, it has also been suggested that patients with vaginal bleeding or pain from a local tumor
mass, or with leg edema due to lymph node involvement, should be treated with pelvic radiotherapy.
Palliation of brain or bone metastases can be effectively obtained with short courses (1–5fractions) of
radiotherapy
RECURRENT DISEASE
7-18%
