Endometrial cancer surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Roukoz A. Karam, M.D.[2]

Overview

Surgery is the mainstay of treatment for endometrial cancer stage I-III.

Surgery

Surgery is the first-line treatment option for patients with endometrial cancer especially if no metastasis is suspected.
The treatment approach is based on staging, pathology, and histologic features of the cancer:^[1]^[2]

Risk	Risk definition	Management	Additional notes
Low risk	• Stage IA endometrial cancer • Well differentiated endometroid histology • Tumor confined to endometrium	Total hysterectomy, bilateral salpingo-oophorectomy, and lymph node evaluation	• Women that opt for preservation of fertility may be candidates for medical therapy • Adjuvant therapy not indicated
Intermediate risk	• Stage I (tumor invades myometrium) or • Stage II (tumor demonstrates cervical stroma invasion) • Tumor usually moderately differentiated or poorly differentiated	• Total hysterectomy, bilateral salpingo-oophorecomy, and lymph node evaluation • Adjuvant radiotherapy is indicated for patients with risk factors	• No data available to recommend adjuvant chemotherapy in these patients • Observation recommended instead of adjuvant radiotherapy if patient has no risk factors
High risk	• Stage III or higher or • Any stage with serous or clear cell carcinoma	• For stage I and II, surgery may be followed by adjuvant vaginal brachytherapy • For stage III and IV, surgery should be followed by adjuvant chemotherapy and pelvic radiotherapy	Giving adjuvant brachytherapy for the high risk early staged tumors depends on patient and provider preferences

References

Overview