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

Objective. Thegoal of this study was to determine the influence of LVSI (lymphvascular space involvement) on the risk of lymph node metastases from endometrial cancer.Methods. All patients with surgically staged endometrial cancer from 1998 to 2000 were identified from divisional databases. The influence of LVSI on the risk for nodal metastases was determined after controlling for tumor grade and depth of invasion, and comparisons were made with the chi(2) or Fisher's exact tests. Multivariable analysis was performed using a logistic regression model.Results. We identified 366 patients who fit the study criteria. Pathologically, 92/366 (25%) tumors had LVSI, and 46 patients (13%) had evidence of pelvic lymph node metastases. Cancers with LVSI were significantly more likely to have nodal disease (35/92 versus 11/274, P < 0.001). When controlled for tumor grade, the presence of LVSI led to an increased incidence of pelvic node metastases (P < 0.001 for all grades). When stratified by depth of invasion in thirds, the presence of LVSI led to a significantly increased chance of pelvic lymph node metastases (P < 0.05 for each strata). When tumor grade and depth of invasion were evaluated together, LVSI led to a significantly increased risk of pelvic node metastases in patients with deeply invasive tumors. In a multivariable analysis, LVSI led to a significantly increased risk for pelvic lymph node metastases (P < 0.05).Conclusion. LVSI leads to an independent and significantly increased risk for pelvic lymph node metastases. As such, the presence of LVSI may indicate the need for lymphadenectomy or adjuvant therapy for potential regional lymph node metastases in patients with unstaged endometrial cancer.
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PMID:Should the presence of lymphvascular space involvement be used to assign patients to adjuvant therapy following hysterectomy for unstaged endometrial cancer? 1246 19

Surgical staging has changed the method by which patients with endometrial cancer are managed. Before the routine use of lymph node dissection, patients were presumed to have nodal disease based on imaging studies, palpation, and biopsy. The move to a surgically based staging system in 1988 created a new subgroup of patients who had documented nodal disease. The risk of nodal involvement is related primarily to tumor grade and depth of myometrial invasion. Although patients with nodal disease are uncommon, treatment of these patients poses multiple challenges. It is our belief that unless nodes are surgically assessed, the clinician will not know whether the nodes are involved. A thorough lymphadenectomy with removal of nodal tissue from multiple pelvic sites and from bilateral para-aortic regions is recommended for most patients with endometrial cancer. Identification of positive nodes allows appropriate postoperative therapies to be used, and data support that nodal dissection may be therapeutic and prognostic. Patients with positive nodes should receive radiation therapy directed to the nodal distribution, with patients having involved para-aortic nodes receiving an extended field. Whole abdominal radiation has been used, especially in patients with adnexal disease or positive cytology. The role of whole abdominal radiation remains in question. The most promising treatment option is combination therapy with sequential radiation and chemotherapy. Active chemotherapy agents in endometrial cancer are doxorubicin, cisplatin, and paclitaxel.
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PMID:Endometrial cancer: treatment of nodal metastases. 1259 38

The objective of this paper is to evaluate the relationship between CD44 expression and the clinicopathologic features of papillary serous endometrial cancer. CD44 expression was assessed in 32 cases of papillary serous endometrial carcinoma by standard immunohistochemical staining techniques. Clinicopathologic features including myometrial invasion, nodal metastases, tumor spread, stage, and the shedding of malignant cells on cervical cytology were reviewed. The Chi-square test was used for statistical analysis. CD44 was not expressed in 81% of patients with papillary serous endometrial carcinoma. Malignant cells were seen on cervical cytology in 68% of all cases with significantly more in the CD44-negative group (78% vs. 33%, P 0.05). CD44 expression was not related to stage, myometrial invasion, nodal involvement, or intraperitoneal spread. We conclude that the cell adhesion molecule CD44 is expressed infrequently in papillary serous endometrial carcinoma. Shedding of malignant cells on cervical cytology is common in papillary serous endometrial cancer and occurs more frequently in CD44-negative cases. CD44 expression doesn't appear to be related to known prognostic features such as nodal metastases or stage. The biologic aggressiveness of this tumor type may, in part, be related to its lack of CD44 expression.
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PMID:CD44 expression in papillary serous endometrial carcinoma. 1291 25

Radical surgery including complete pelvic and para-arortic lymph node dissection (LND) is both the main therapeutic effort and the decisive staging procedure in patients with invasive endometrial cancer (EC) and should be performed in specialized institutions. Vaginal cuff brachytherapy holds little serious side effects and may be beneficial in preventing vaginal recurrences. External irradiation treatment no longer has a routine indication in primary therapy. The omission of retroperitoneal staging (LND) at primary surgery does not indicate adjuvant radiotherapy but rather second-effort surgery removing pelvic and para-aortic lymph-nodes. External radiotherapy should be reserved for fully staged patients with residual non-resectable tumor manifestation and/or nodal involvement in relation to the extent of tumor involvement and surgical intervention. Hormonal and cytotoxic therapy is experimental in the adjuvant setting. The first step in palliative systemic treatment should be the administration of endocrine therapy when the tumor expresses progesterone receptors and tumor manifestations are not acutely life-threatening. In other cases or when endocrine treatment fails chemotherapy may be considered, which is often limited due to its toxicity. Preferably, palliative hormonal and/or chemotherapy should be administered in controlled clinical trials.
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PMID:Endometrial cancer. 1460 58

The case histories of 95 patients with endometrial carcinoma treated between July 1998 and December 2002 were reviewed. These patients were staged according to FIGO classification and included peritoneal cytology, total abdominal hysterectomy/bilateral salpingo-oophorectomy (TAHBSO), and pelvic with or without para-aortic lymphadenectomy. The FIGO surgical stages were as follow: IA, 9 (9.5%); IB, 35 (36.8%); IC, 16 (16.8%); IIB, 10 (10.5%); IIIA, 5 (5.3%); IIIB, 1 (1.1%); IIIC, 19 (20.0%). In addition to TAHBSO, 47 (49.5%) patients had pelvic lymphadenectomy whereas 48 (50.5%) had both pelvic and para-aortic lymphadenectomy. Nineteen (20.0%) of 95 patients had nodal metastases. Positive pelvic and para-aortic lymph nodes were found in 15 (15.8%) of 95 and 12 (25.0%) of 48 patients, respectively. According to the result of the lymphadenectomy, 19 (20.0%) patients had their surgical stage upgraded to stage IIIC and 61 (64.2%) patients had a change in their management plan. Twelve (12.6%) patients required extended field irradiation due to para-aortic nodal metastases and 49 (51.6%) patients with negative nodes avoided postoperative external radiotherapy. By defining the lymphatic spread via surgical staging, postoperative radiotherapy can be recommended to patients with nodal metastases, while it can be withheld from those patients with negative nodes, irrespective of the presence of risk factors.
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PMID:The value of pelvic and para-aortic lymphadenectomy in endometrial cancer to avoid unnecessary radiotherapy. 1467 25

The objective of this study was to evaluate the potential survival benefit of debulking macroscopic adenopathy and other clinical prognostic factors among patients with node-positive endometrial carcinoma. Demographic, operative, pathologic, and follow-up data were abstracted retrospectively for 41 eligible patients with FIGO stage IIIC endometrial cancer. Survival curves were generated using the Kaplan-Meier method and statistical comparisons were performed using the log rank test, logistic regression analysis, and the Cox proportional hazards regression model. All patients had positive pelvic lymph nodes and 20 patients (48.8%) had positive para-aortic lymph nodes. Postoperatively, all patients received whole pelvic radiation therapy, 17 received extended-field radiation therapy, and 15 patients received chemotherapy. The median disease-specific survival (DSS) time for all patients was 30.6 months (median follow-up 34. 0 months). Patients with completely resected macroscopic lymphadenopathy had a significantly longer median DSS time (37.5 months), compared to patients left with gross residual nodal disease (8.8 months, P = 0.006). On multivariate analysis, independent predictors of DSS were gross residual nodal disease (HR 7.96, 95% CI 2.54-24.97, P < 0. 001), age > or = 65 years (HR 6.22, 95% CI 2.05-18.87, P = 0.001), and the administration of adjuvant chemotherapy (HR 0.22, 95% CI 0.07-0.76, P = 0.016). We conclude that in patients with stage IIIC endometrial carcinoma, complete resection of macroscopic nodal disease and the administration of adjuvant chemotherapy, in addition to directed radiation therapy, are associated with improved survival.
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PMID:FIGO stage IIIC endometrial carcinoma: resection of macroscopic nodal disease and other determinants of survival. 1467 52

For half a century, adjuvant radiation therapy has been an important component in the treatment of patients with early-stage endometrial cancer believed to be at significant risk of local or regional recurrence. The widespread adoption of up-front surgical treatment and staging, including nodal assessment, has raised new questions about the need for and extent of postoperative adjuvant treatment. Furthermore, in some institutions, even in the absence of complete surgical staging, the extent of postoperative adjuvant treatment is being reassessed. These developments have increased interest in the use of intravaginal brachytherapy (IVRT) alone in selected patients whose major risk of recurrence is at the vaginal cuff. The potential advantages of this approach include lower cost and decreased acute and late toxicity. The use of IVRT alone in select patients was examined through a review of the available literature. The authors conclude that there is a subset of patients in whom adjuvant treatment with IVRT alone is adequate. A clinical approach involving patient selection criteria is proposed which suggests separate selection criteria based on whether or not complete surgical staging information is available.
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PMID:Early-stage endometrial cancer: is intravaginal radiation therapy alone sufficient therapy? 1506 72

In gynecologic malignancies, regional lymph node status is a major prognostic factor and a decision criterion for adjuvant therapy. This is the basis for lymphadenectomy. The sentinel node (SN) procedure has emerged as an alternative to systematic lymphadenectomy in various cancers, reducing treatment-related morbidity. In melanoma and breast cancer, SN biopsy is the standard procedure for determining nodal stage. Use of the SN procedure is also well established in vulvar cancer. In small series, combined SN detection based on blue dye and radiocolloid was suitable for the evaluation of lymph node status in cervical cancer. Although some investigators have reported the feasibility of the SN procedure in endometrial cancer, further studies and standardization are required before its routine use can be recommended.
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PMID:Lymphatic mapping for gynecologic malignancies. 1519 Apr 97

The objective of this study was to evaluate the relationship between cervical cytology, histologic type, and risk of endometrial cancer recurrence. We performed a retrospective study of patients undergoing surgery for endometrial carcinoma. Risk factors for recurrence including histology, tumor grade, nodal status, myometrial invasion, peritoneal washings, stage, and cervical cytology were assessed. Abnormal cervical cytology was defined as the presence of any endometrial cells on Pap smear. Papillary serous and clear cell carcinomas were considered high-risk histologies. Univariate and multivariate analyses of risk factors for recurrence were performed. Thirty-nine (9%) patients developed recurrent endometrial cancer. More patients with abnormal Pap smears recurred (12% versus 4%, P < 0.05). For endometrioid adenocarcinoma, abnormal cervical cytology occurred in 61% and 7% recurred, while with high-risk histologies, 84% had abnormal cervical cytology and 19% recurred (P < 0.05). Other significant predictors of recurrence on univariate analysis were myometrial invasion, nodal status, washings, stage, and histology. On multivariate analysis, only nodal status remained a significant predictor of recurrence. Abnormal cervical cytology is associated with increased risk of endometrial cancer recurrence. Abnormal cervical cytology occurs more frequently in high-risk histologies, which are known to have a higher risk of recurrence. On multivariate analysis, only nodal spread remains a significant predictor of recurrence.
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PMID:Abnormal cervical cytology: a risk factor for endometrial cancer recurrence. 1588 79

A 58-year-old woman was diagnosed with endometrial carcinoma. Total hysterectomy, bilateral salpingo-oophorectomy and paraaortic and a pelvic lymph node dissection were performed. The cytology of peritoneal fluid was negative. There was no peritoneal dissemination except umbilical nodule. A peritoneal 2.0x1.5 cm umbilical nodule was also resected. The nodule was identified as a metastasis from endometrial cancer with endometriosis. The pelvic lymph nodes also showed metastatic lesion with endometriosis. Our case showed that endometriosis coexisted with umbilical and pelvic lymph nodal metastatic lesions from endometrial cancer. This fact suggests that the mode of metastasis to the umbilicus via lymph flow from endometrial cancer is the same as that for endometriosis.
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PMID:Sister Joseph umbilical nodule coexisting with endometriosis from endometrial carcinoma. 1609 37


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