Endometrial cancer

Endometrial carcinoma is the most common gynaecological malignancy in the Western world. The standard management of endometrial carcinoma is total hysterectomy and bilateral salpingo-oophorectomy with or without pelvic and para-aortic lymph-node dissection. Increasingly, endometrial cancer is being diagnosed in younger women in whom preserving fertility may be an important consideration when deciding optimal management. Conservative management of endometrial carcinoma may be a therapeutic option in carefully selected women with well-differentiated endometrial cancer in the absence of any myometrial invasion or adnexal disease seen on imaging. The biggest concern with conservative management of endometrial carcinoma is disease progression while on treatment or after initial response to medical treatment. Women opting for conservative management should be aware that hormonal therapy is not the standard form of management. Potential adverse outcomes should be taken into consideration.     

Endometrial cancer

Endometrial cancer is the most common gynaecological malignancy in the United Kingdom, and an understanding of its presentation and management options is required for all gynaecologists. The surgical management of endometrial cancer has expanded to include laparoscopic surgery, and debate is ongoing regarding the utility of pelvic and para-aortic lymphadenectomy. Our understanding of the biology of endometrial cancer may help determine which women may benefit most from chemo- or hormonal therapy, which may be promising in an adjuvant setting. Pelvic radiation is associated with better local control. Combination therapy with radiation and chemotherapy is under evaluation.     

Endometrial cancer

The overall long-term survival for patients with endometrial carcinoma has led to a commonly held view that simple hysterectomy with oophorectomy provides adequate surgical treatment. However, it has been known for 30 years that nodal spread occurs in about 25% of patients with disease clinically confined to the uterus and that high survival rates are only seen for patients with adenocarcinomas. FIGO staging now requires histological examination of nodal specimens in all patients. Whether lymphadenectomy is a therapeutic as well as diagnostic procedure is being addressed in current randomized trials. Radiotherapy reduces the incidence of pelvic recurrence but has no effect on survival. The response to cytotoxic therapy is less than 50% and the duration of response approximately 1 year. Whilst treatment with hormonal therapy may be non-toxic the results are disappointing. Since the most important prognostic factors can be determined preoperatively, appropriate surgery, in an appropriate clinical setting, can now be expected.     

Endometrial cancer

Endometrial cancers are the most common gynaecological malignancies in the UK with approximately 4500 new cases occur each year and the incidence is rising. Increasingly there is evidence-based management and centralized specialist care of women with endometrial cancer. Women with high grade disease, deep myometrial invasion or lymphadenopathy should be managed by specialist gynaecological oncologists as part of a multi-disciplinary team (MDT). Results from important clinical trials now guide the application of surgical and non-surgical treatments. Surgery remains the cornerstone of management with a trend towards increased use of minimal access surgery. Radiotherapy-related morbidity can now be reduced by the more selective use of external beam radiotherapy. There remain several unresolved issues however and it is important that relevant clinical trials are offered to eligible women. Women must have multi-disciplinary input before treatment, so that up-to-date and evidence-based treatments and inclusion in clinical trials can be considered.     

Endometrial cancer

The incidence of endometrial cancer in the UK has risen steeply since the 1990s. It is not one but several different diseases with different aetiologies, histological and molecular characteristics and prognosis. Survival has improved significantly over several decades but outcomes for 25% of women remain poor. Surgery is the main treatment. Radiotherapy and chemotherapy are used to reduce recurrence, and for upfront treatment in selected cases. Following years of debate about the role of lymphadenectomy, sentinel node surgery now offers accurate surgical staging without the morbidity of systematic lymphadenectomy. Advances in laboratory analysis of tumours are likely to improve care further. Molecular characterisation now offers better risk stratification and a tailored approach to the use of post-operative treatment. The introduction of widespread testing of tumours for genetic abnormalities, improves identification of at-risk families. The traditional model of hospital follow-up has also been replaced with a more patient-centred risk-stratified approach.     

Endometrial cancer

Despite the questions and barriers, the incorporation of molecular therapy into treatment regimens in endometrial cancer is an exciting area of investigation with the potential to improve outcomes. Outside of the development of a reliable screening test for endometrial cancer, converting the disease to a chronic state and improving progression-free survival is our best hope to reverse the concerning trend of decreasing 5-year survival for this disease.     

子宫内膜癌临床问题讨论

孔北华教授子宫内膜癌(endometrial cancer,EC),即子宫体癌(carcinoma of corpus uteri)是妇科常见恶性肿瘤,在西方发达国家发病率位居妇科肿瘤首位,在我国妇科肿瘤患者中,发病率可能仅次于宫颈癌。近年来,其发病率无论在西方国家还是在我国均有升高趋势。该病因绝经后异常阴道     

Endometrial cancer. Epidemiology

In evaluating these trends in the East-West comparison, one notes that the epidemiologic features connoting high risk are similar in both cultures; while they are more common in the West, they are more strongly associated in the East. Clearly, a prospective interview method of obtaining reproductive data will be more informative for such a crosscultural study with greater numbers lending better support. In summary, there exists a grouping of reproductive phenomena fairly common in Western societies that are related to higher risk for endometrial cancer, and we have noted similar characteristics in Eastern women who have developed this disease, while control groups in Eastern societies where this disease is uncommon have a low profile for such attributes in comparison to the West.     

Endometrial cancer: our experience

The Authors have referred to their experience based on 293 endometrial cancer patients operated at the II University Gynecological Clinic in Catania, between 1975 and 1989. Many prognostic indicators such as stage, histologic grade, myometrial invasion depth, lymph-node metastasis, non-neoplastic endometrium histology, tumor size and histology were studied; the Authors affirm the validity of two risk factors such as tumor size and the histology of the non-neoplastic endometrium, readily observable by hysteroscopy during the preoperative assessment and which are well correlated with the depth of myometrial invasion and lymph node methastasis.     

Endometrial cancer following endometrial resection

Endometrial ablation has emerged as a viable alternative to hysterectomy in the treatment of medically intractable dysfunctional uterine bleeding. However, this procedure cannot guarantee complete removal of the entire endometrium. Cases of endometrial cancer after endometrial ablation have been reported in the literature. We reviewed the cases of patients who underwent hysteroscopic endometrial ablation by endometrial resection for abnormal uterine bleeding from 1994 to 2005 at the Department of Obstetrics and Gynecology, Polyclinique, Clermont-Ferrand University. Of the 3769 patients having had hysteroresections, four developed endometrial cancer after complete endometrial ablation (1.06 out of 1000). All four of these patients showed histological evidence of endometrial polyps at endometrial resection, and all of them presented risk factors for endometrial carcinoma, such as obesity and/or arterial hypertension. Endometrial cancer after hysteroscopic endometrial ablation is a rare but possible occurrence, even a long time after the operation. Close monitoring of patients who have undergone endometrial ablation for endometrial polyps and who present risk factors, such as obesity or hypertension, even after apparent total ablation of the endometrium is strongly recommended, independently of the presence of abnormal bleeding that can represent a late symptom of advanced endometrial cancer.     

Endometrial cancer in HNPCC syndrome

The Hereditary Non-Polyposis Colorectal Cancer syndrome (HNPCC) has initially been described as a predisposition to colorectal cancers (CRC). Subsequently, other cancers, such as endometrial cancers (EC), have been added. The objective of this review was to update data on endometrial cancers of HNPCC syndrome. Endometrial cancers of the HNPCC syndrome are characterized by a younger age at diagnosis (46-48 year old), and a higher cumulative risk along life (30% at 70 years). Complex atypical hyperplasia seems to occur before the cancer, but the transition between precursors and cancer seems to be short. Histology of endometrial cancers of the HNPCC syndrome appears quite similar to that of sporadic cases, except for non-endometrioid lesions which seem more frequent and could occur in younger women. Screening of endometrial cancer in predisposed women should associate annual clinical examination, transvaginal sonography and endometrial sampling. Unfortunately, available data on screening by sonography show that this test seems poorly accurate, with no asymptomatic cancer or hyperplasia recognized and interval cancers between screenings. Endometrial biopsy appears as the most interesting method, since 11 asymptomatic cancers and 14 hyperplasia have been diagnosed in 175 mutation carriers. Diagnostic hysteroscopy seems also interesting, but requires further evaluation. Prophylactic hysterectomy confers a complete protection against endometrial cancer. However, perioperative morbidity (especially in women with history of colorectal surgery) and long-term effects of ovarian suppression should also be considered. Screening of endometrial cancer remains the main objective of the management of those patients. Endometrial biopsy should have a larger place.     

Endometrial cancer: molecular and therapeutic aspects

Endometrial cancer (EC) is the most commonly diagnosed gynecologic malignancy. Although early-stage EC is effectively treated surgically, commonly without adjuvant therapy, the treatment of high-risk and advanced disease is more complex. Chemotherapy has evolved into an important modality in high-risk early-stage and advanced-stage disease, and in recurrent EC. Multi-institutional trials are in progress 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.     

Endometrial aspiration in fertility control. A report of 500 cases.

Outpatient endometrial aspiration was offered to patients who suspected that they were pregnant, but were within 5 to 21 days after failure of expected menstruation and had a uterus of normal size on pelvic examination. This is a report of 500 consecutive cases treated between September, 1973, and April, 1975. Histologic examination of the aspirated tissue was obtained on all 500 cases (100 per cent). Follow-up examination and urine pregnancy was obtained on 407 patients (81.4 per cent). Histologic evidence of pregnancy was obtained in 323 patients (64.6 per cent). Complications were limited to five infections (1 per cent), only one of which led to hospitalization of the patient, and failure to completely evacuate the pregnant uterus in 39 patients (12.1 per cetn of the 323 pregnant). Thirty-four of these had the uterus emptied by a second outpatient procedure and five patients were hospitalized to complete their abortion.     

Endometrial cancer following radiation therapy for cervical cancer

The clinical and histologic features of eight cases of carcinoma of the endometrium which developed following radiation therapy for squamous cell carcinoma of the cervix are described. No patient had a well-differentiated tumor and significant myometrial invasion was present in all cases. Three of the eight tumors were papillary serous adenocarcinoma. Five of the eight patients developed recurrent tumor and died of their disease. The risk of endometrial cancer in patients previously radiated for cervical cancer is evaluated.