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Abstract

Endometrial carcinoma

Generally,we can distinguish between estrogen associated endometrioid type-I, non-endometrioid type-II and hereditary type-III-carcinomas.Type-II-carcinomas usually have a bad prognosis. Most of endometrial stage I cancers are curable by hysterectomy with bilateral salpingooophorectomy. Lymphadenectomy can be omitted if all (!) of the following conditions are realized: endometrioid subtype also with squamous differentiation, stage I grade 1/2 tumour with less than 50% myometrial invasion,and tumour diameter ? 2 cm. On the other hand, systematically pelvic and para-aortic lymphadenectomy is mandatory if one (!) of the following conditions is present: grade 3, stage IC and higher (except cytological stage IIIA), tumour size > 2 cm, papillary-serous, clear cell,squamous, and undifferentiated carcinomas regardless of myometrial invasion, lymphatic and blood vessel invasion. In papillaryserous and clear cell carcinomas, the addition of omentectomy and appendectomy is necessary. Only in bulky stage-II-cancers a radical hysterectomy with lymphadenectomy should be performed. An adequate laparoscopic procedure seems to have equal results.

With exception of stage IA grade 1/2 tumours an intracavitary brachytherapy of the vaginal vault is generally recommended.Postoperative external beam irradiation is indicated only in inadequately operated patients and if lymph nodes are positive.At time there are no valid data for an adjuvant chemo- or hormone therapy, but in very high risk of relapse a sequential chemo-radiotherapy is generally accepted. Primary hormonal therapy with progestins is possible only in endometrioid receptor positive stage I, grade 1 carcinomas.Therapy of choice in local relapses is surgery and/or irradiation. Receptor positive metastases can be treated with progestins. Patients with heavy symptomatic or threatening metastases and/or receptor negative cancer should get chemotherapy. In some cases, a laser induced therapy is possible.

Günter Köhler

Reviewer: Werner Lichtenegger, Berlin,
und Walther Kuhn,Bonn

CME Praktische Fortbildung Gynäkologie, Geburtsmedizin und Gynäkologische Endokrinologie 1/2006: 70 - 82