Endometrial Cancer: Natural History, Diagnosis, and Treatment

Posted on Feb 21, 2025 in Biomedical Sciences

Endometrial Cancer: Natural History

ITEM 17: Natural History of ENDOMETRIAL CANCER

Endometrial cancer, limited to the uterus, may not involve lymph node metastasis (LN). When diagnosing, consider that local growth originates without uterine mucosa involvement and may extend in two main ways:

  • Extension into the uterus
  • Extension into the myometrium

Pathological Classification

The vast majority of endometrial cancers are adenocarcinomas, including:

  • Endometrioid
  • Serous papillary
  • Mucinous
  • Clear cell
  • Mixed cell carcinoma

General Cancer Treatment

SARCOMAS: If diagnosed at an early stage, surgery is the best option. The technique employed is hysterectomy + total double anextectomía (oophorectomy). This involves removing the entire uterus by closing the vaginal depth (hysterectomy). The anextectomía consists of ovary removal. If there is myometrial invasion or the tumor is high grade, surgical treatment should be supplemented with adjuvant radiation therapy (RT). Preoperative RT can mask pathology results. Adjuvant hormonal therapy in stage I and II has not demonstrated improved survival.

Stage I Treatment

Treatment includes total hysterectomy with double oophorectomy, lymph node sampling, and peritoneal lavage. In stage IA of any histological grade (G1, G2, G3) and stage IB G1, surgery alone is sufficient. In IB, G2, brachytherapy (BQ) to the vaginal cuff should be applied after surgery. In all other cases of stage I, external RT in the pelvic area (lymph node chains) and BQ to the vaginal cuff are applied after surgery. If there are medical contraindications to surgery, external RT therapy alone and BQ should be performed, although the cure rate is lower than with surgery.

Stage II Treatment

Surgery + adjuvant external RT to the pelvic nodal chains and BQ to the vaginal cuff. Alternatively, preoperative external RT and BQ followed by surgery.

Stage III Treatment

Surgery is not recommended. Treatment consists of external RT and BQ.

If previously treated with surgery for stage I or II, adjuvant external RT and BQ, radiating to the aortic lymph node area (lower abdomen), is advisable. Some studies have proposed total abdominal irradiation.

Stage IV Treatment

  • IVA: External RT + BQ
  • IVB: Hormone therapy if possible. Clinical evaluation using chemotherapy (taxol) is ongoing.

Volume White (Target Volumes)

  1. Surgical bed if surgery
  2. Uterus in full if no surgery
  3. Parametrium (area around the uterus)
  4. 2/3 upper vagina
  5. Pelvic lymph nodes
  6. Antero-posterior to aortic lymph nodes (+/-)
  7. Antero-posterior abdominal cavity (+/-)

Technique Mobile Band

On Day 1, one band of 2.5 cm is used for the field. Each subsequent day, another band is added until the 4th day (4 x 2.5 cm bands = 10 cm). On the 5th day, the 4 bands are used again, shifting from the 2nd to the 5th position.

Adjuvant Treatment to Radical Surgery

Surgical and irradiated pelvic nodal chains with 50 Gy. Double exposure to 2/3 higher vagina with high-dose-rate brachytherapy. If indicated, radiate for aortic lymph node chains using a 45 Gy racquet field and continue with pelvic irradiation to 50 Gy.

Palliative Treatment

To achieve hemostasis (stopping bleeding), irradiate the pelvic area with 30 Gy and, if necessary, the metastatic location.