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Query: UMLS:C0476089 (endometrial cancer)
 11,379 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A retrospective analyses of 307 cases with clinical Stage I endometrial carcinoma was done in an attempt to determine the role of radiation therapy in the optimal treatment of this disease. A review of the modern literature with over 9000 cases served as a useful tool to corroborate inferences and conclusions. The present series has 155 patients (51%) treated with preoperative megavoltage external pelvic radiation with a variation in doses of less than 6%. Five-year survival estimates (79%-83%) in clinical Stage I endometrial carcinoma are similar among the several main treatment combination that are employed; they become a useless parameter for any comparison. The pelvic failure rate constitutes a more useful guideline in assessing the most adequate therapy. The pathologic grade of the tumor is the main prognosticator in endometrial carcinoma. Intimately related to the tumor grade is the depth of myometrial invasion of the carcinoma. The size of the uterus and/or its cavity carry less prognostic significance than traditionally thought. For grade I lesions, there is little error in diagnosis, few pelvic failures and excellent survival (96%); they could be approached with initial surgery and postoperative radiation reserved for selected patients. For grade 2 tumors, the error in diagnosis and the failure rate increases with an overall survival of 87%. For grade 3 tumors, the error in diagnosis and failure rates are quite high with a 5 year survival of only 70%. Preoperative radiation, especially external beam therapy, is suggested for grades 2 and 3 Stage I tumors. The use of this treatment modality yields only 3% pelvic failure and an overall 5 year survival of almost 90%.
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PMID:The management of clinical stage I endometrial carcinoma. 63 42

The impact of para-aortic field radiation therapy upon survival was studied among 26 patients with para-aortic nodal metastases from carcinoma of the endometrium. Seventeen of these 26 patients received postoperative radiation therapy to the para-aortic field as a part of their primary therapy. Sixteen of the 17 also received adjuvant hormonal therapy. Nine of 17 patients (53%) are alive without evidence of disease (18-55 months) with a median survival time of 27 months. Of the remaining eight patients, six (35%) died of endometrial cancer at 6-38 months, with a median survival time of 14.5 months. Five of these patients had distant disease. Two of the 17 patients (12%) died of intestinal obstruction felt to be secondary to radiation enteritis, one of whom was disease free. No difference in survival was detected in patients treated with radiation therapy with microscopic versus macroscopic nodal involvement. Of the nine patients who did not receive para-aortic radiation, eight were treated with hormonal therapy (n = 6) or chemotherapy (n = 2). Seven patients died of disease from 5-28 months, with a median survival time of 13 months. One patient is alive at 12 months. Survival in the 17 patients treated with para-aortic radiation was better than the eight patients not treated with para-aortic radiation (p = 0.004). This survival difference remained significant for patients with microscopic but not macroscopic nodal disease. Para-aortic field radiation appears to improve survival, but has a significant complication rate, and should be reserved for patients with histologic evidence of para-aortic metastases.
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PMID:Radiation therapy for surgically proven para-aortic node metastasis in endometrial carcinoma. 152 60

280 patients were treated at the Institute Bordet between 1963 and 1977 for endometrial carcinoma. 149 patients had radiotherapy alone, 65 patients had radiotherapy before operation and 66 patients after operation. Radiation alone was reserved for those patients whose operative risk was very serious. Five year survival was 49.6% after irradiation alone in Stage I tumours (A "packing" technique was used to deliver the radiation therapy). 22.7% of these patients died of intercurrent diseases. The majority of the recurrences were in the uterus. This series confirms the prognostic importance of the clinical staging, of the length of the uterine cavity and the degree of differentiation of the tumour. The five year survival rate after postoperative irradiation is 75%, and 84% after preoperative irradiation. Though the association of surgery with irradiation gives better results for those patients who can be operated on, it must be pointed out that radiotherapy alone gives a chance of curing an important percentage of patients whose surgical risk is in a major category.
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PMID:[Cancer of the endometrium and radiotherapy. Review of 280 patients treated at the Institut Bordet]. 400 86

Three hundred and thirty-three consecutive patients with adenocarcinoma of the endometrium treated from 1958 to 1978 by combined surgery and radiation therapy or radiation therapy alone were reviewed. According to the FIGO staging system, there were 204 stage I, 40 stage II, 24 stage III and 20 stage IV. 40 cases of recurrences were also included in this study. The main parameters influencing survival were clinical staging, depth of myometrial invasion, histologic differentiation as well as the possibilities of radical surgery in these patients. Analysis of therapeutic results shows the superiority of pre-operative intra-cavitary irradiation followed by total abdominal hysterectomy and bilateral salpingo-oophorectomy with an 80% actuarial survival at five years in stage I. Primary surgery followed by radiation therapy gives inferior results, particularly in stage II. Treatment by radiation therapy alone should be reserved for inoperable patients after careful evaluation and gives a 35% actuarial survival at five years. The incidence of serious therapeutic complications was 3,6 %. The early diagnosis of endometrial carcinoma by means of systematic endo-uterine explorations in post-menopausal bleeding and the elaboration of combined multi-modality protocol prior to any treatment should lead to a better cure rate for this cancer of increasing incidence.
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PMID:[A study on 333 patients with adenocarcinoma of the endometrium treated by combined surgery and radiation therapy (author's transl)]. 627 42

The role of this research is to define the clinical-therapeutic approach to endometrial cancer currently being followed in some of the most important centres of reference for gynaecological cancer in Western Europe. Data was collected by means of a questionnaire, concerning specific diagnostic and therapeutic options, sent to 115 leading centres for gynaecological oncology in Western Europe, and 82 responses were received. The analysis of the management of this neoplasia in Western European countries shows significant differences regarding some particular clinical conditions. Only 24.4% of the interviewed centres stated that they perform lymphadenectomy routinely, whereas it is most commonly reserved for specific pathological conditions. The presence of lymph node spread is generally considered to be the most important prognostic element, and currently, radiotherapy of the pelvis appears to be the treatment of choice either as the sole postsurgical therapy (57%) or in combination with systemic treatment. An adjuvant treatment in stage I lymph node-negative patients is adopted in the large majority of the centres (70.5%) when poorly differentiated cancer (46%) and/or deep myometrial invasion (33.3%) are present. In this condition, radiotherapy appears to be the therapy of choice. Histotype and grading are generally recognised as important risk factors and result in treatment modification; the high percentage of primary surgical modifications is considerable (63.4%) in stage I grade 3 cancers that primarily require lymphadenectomy or recourse to radical hysterectomy. The results of our study indicate that there is no leading therapy in the advanced stages of endometrial cancers, but each therapeutic modality is adopted to more or less the same extent.
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PMID:An analysis of approaches to the treatment of endometrial cancer in western Europe: a CTF study. 856 54

The study was conducted on 748 women who reported genital bleeding occurring at least one year after the last menstruation. Benign causes were most frequent than malignant causes. Among the benign causes, the most frequent were cervicitis (19.95%), prolapsed uterus with decubitus ulcer (19.41%), dysfunctional hemorrhage (13.29%) and endometrial polyps (12.77%). In the group of malignant causes, cancer of the cervix was the neoplasm most often detected (59.26%); endometrial cancer was next, affecting 29.63%. The cancer of the cervix/cancer of the body ratio was 2:1. In summary, many causes, both benign and malignant, can provoke abnormal postmenopausal bleeding. Thus, curettage of the uterus should be reserved for doubtful cases, i.e., in situations in which, after all non invasive methods of investigations have been exhausted, the possibility of the occurrence of malignant lesions still persist.
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PMID:Postmenopausal genital bleeding. 872 42

Pelvic and aortic lymphadenectomy have been incorporated into the FIGO staging for endometrial carcinoma although the indications for lymphadenectomy were undefined. When lymphadenectomy is carried out, however, both the pelvic and para-aortic lymph nodes are usually removed. This policy has limited the ability to manage patients with endometrial carcinoma laparoscopically because many women who have endometrial cancer are obese, and aortic lymphadenectomy is frequently difficult to carry out in patients weighing 180 pounds or more. Data are presented to show that the presence of pelvic lymph node metastases provide a better criterion for aortic lymphadenectomy than deep myometrial invasion. If positive pelvic nodes rather than deep myometrial invasion were used as the criterion for aortic lymphadenectomy, 23% more women with aortic lymph node metastases would be identified, and 35% fewer aortic lymphadenectomies would need to be carried out, although these would need to be performed as a second operation. Data are also presented to show that pelvic lymphadenectomy can be carried out laparoscopically in women weighing 180 pounds or more. Our heaviest patient weighed 300 lbs. Because obese women tend to have more favorable lesions, few will be found to have pelvic lymph node metastases, and therefore few will require aortic lymphadenectomy. I conclude, therefore, that most women with endometrial carcinoma can be successfully managed laparoscopically if they are treated by laparoscopic hysterectomy and pelvic lymphadenectomy, and aortic lymphadenectomy is reserved for those who have positive pelvic nodes.
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PMID:Pelvic and Aortic Lymphadenectomy in Endometrial Cancer 907 94

Although the majority of patients with endometrial cancer have a good prognosis, subgroups of individuals are at risk of more aggressive disease. Early detection programs should target individuals who have the highest risk of advanced disease, high-risk histology, and poorly differentiated tumors. This will afford the greatest improvement in survival. Screening of the general population is not cost-effective and indeed may incur iatrogenic morbidity. Recent data also suggest that routine screening of patients receiving tamoxifen citrate may not be indicated. This area is still being investigated. While screening is not appropriate for the general population, a strategy of early evaluation of postmenopausal bleeding with judicious use of endometrial biopsy is important for the early detection of endometrial cancer. Ultrasound is most effective in excluding pathology in symptomatic patients whose biopsy specimen is nondiagnostic. Fractional dilation and curettage is reserved for patients with abnormal vaginal bleeding who cannot undergo office biopsy or who experience persistent symptoms.
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PMID:A review of screening and early detection of endometrial cancer and use of risk assessment. 916 14

The aim of this paper is to report the risk of development of gynecological cancer in women receiving hormone replacement therapy and to review the current knowledge on the administration of hormone replacement therapy following treatment of gynecological cancer. Estrogens alone may act as promoting factors for endometrial carcinogenesis. However, the addition of progestins reduces the risk of endometrial cancer to that of nonusers. Hormone replacement therapy could be given to selected patients following treatment for endometrial cancer. However, we think that this therapy should be reserved only for patients enrolled in controlled clinical trials. Ovarian cancer does not seem to be sensitive to estrogens, even if current literature does not allow firm conclusions to be drawn. Hormone replacement therapy should be offered to patients previously treated for ovarian cancer and cervical cancer.
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PMID:Hormone replacement therapy and gynecological cancer. 942 82

Endometrial adenocarcinoma is the most common gynecologic malignancy. Strategies for treatment of this disease should not only emphasize quality of care resulting in cure of disease, but also use health care resources in the most efficient manner possible. Based on available data, we recommend that all patients with the diagnosis of endometrial carcinoma undergo complete surgical staging with lymph node dissection. Radiation therapy is reserved only for patients with evidence of extrauterine disease. This approach maximizes the amount of information available for treatment planning and offers the potential therapeutic advantage of lymph node dissection. Additionally, in a cost analysis, this approach appears to be the most cost-effective.
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PMID:Complete surgical staging of early endometrial adenocarcinoma: optimizing patient outcomes. 1067 52


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