Endometrial Cancer
Diagnosis
1. Fr D&C + cervical biopsy
2. Hysteroscope directed biopsy
Risk factor
1. Obesity
2. Nulliparity
3. Late menopause
| Stage |
|
| Ia G123 |
Tumor limited to endometrium |
| Ib G123 |
Invasion of less than half of the myometrium |
| Ic G123 |
Invasion of more than half of the myometrium |
| IIa G123 |
Endocervical glandular involvement only |
| IIb G123 |
Cervical stromal invasion |
| IIIa G123 |
Tumor invades serosa 、 adnexae 、 positive cytology |
| IIIb G123 |
Vaginal metastases |
| IIIc G123 |
Metastases to pelvic and/or paraaortic lymph nodes |
| IVa G123 |
Tumor invasion of bladder and/or bowel mucosa |
| IVb |
Distant metastases 、 inguinal lymph node |
Histopatholgoy: Degree of differentiation
Cases of carcinoma of the corpus should be grouped according to the degree of differentiation of the adenocarcinoma as follows:
G1 = 5% or less of a nonsquamous or nonmorular solid growth pattern
G2 = 6% to 50% of a nonsquamous or nonmorular solid growth pattern
G3 = more than 50% of a nonsquamous or nonmorular solid growth pattern
Pre-operative survey
1. Sonography
2. Abdomino-pelvic CT
3. MRI (optional)
4. IVP
5. LGI
Primary treatment
1. Comprehensive surgery
washing cytology + ATH (or Extended ATH) + BSO + Bilateral pelvic lymph node dissection + paraaortic LN sampling analysis (when Gr3 or deep myometrial involvement)
2. specimen sent for hormone receptor and flow cytometricDNA ploidy
Risk factor (indicators for post-operative therapy)
1. Histologic differentiation
2. Stage of disease
3. Myometrial invasion
4. Peritoneal cytology
5. Lymph node metastasis
6. Adnexal metastasis
7. Hormonal receptor
8. DNA ploidy
Adjuvant therapy
1. Radiotherapy:
a. whole pelvis with/or without vaginal brachytherapy
b. whole pelvis + entended PA field
2. Chemotherapy:
a. splatin, adriamycin, epirubicin, paciltaxel
3. Hormone therapy:
a. megestrol acetate: 160 mg/d-320 mg/d
b. tamoxifen: 20-60 mg/d
c. GnRHa: Lupron depot 3.75 mg SC/month