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Diagnosis
and treatment - Endometrial (uterine) Cancer
Diagnosis
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Physcial
examination including pelvic examination by the doctor
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The
Pap test is often performed during a pelvic exam. Pap Smear
is more useful for cancer of cervix then in uterine cancer.
A sample of cells from the cervix and upper vagina are
collected using a brush or wooden spatula and these cells
are sent to medical laboratory to be checked for abnormal
changes.
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Ultrasound
of abdomen
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A
biopsy is necessary to confirm the diagnosis. A small sample
of tissue from the uterine lining is taken and a pathologist
examines the tissue to check for cancer cells or other
conditions. Biopsy helps in determining the cellular type of
cancer and whether there are hormone receptors present on
the tumor.
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Further
tests like CT scan, MRI, bone scan, X-ray chest might be
used to determine the extent of disease and metastasis
The
following Cellular Classification of endometrial cancer
is based on cell types seen on biopsy-
The
most common endometrial cancer cell type is endometrioid
adenocarcinoma, which is composed of malignant glandular
epithelial elements. Frequency of endometrial cancer cell types
is as follows:
| 1.
Endometrioid Adenocarcinoma (75%-80%)
2.
Ciliated adenocarcinoma.
3. Secretory
adenocarcinoma.
4. Papillary or
villoglandular.
5.
Adenocarcinoma with squamous differentiation
6. Adenosquamous
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7.
Adenoacanthoma
8. Uterine papillary
serous (<10%).
9.
Mucinous (1%)
10. Clear cell (4%).
11. Squamous cell (<
1%)
12. Mixed (10%).
13.
Undifferentiated
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Endometrial
cancer can be grouped with regard to the degree of
differentiation of the adenocarcinoma, as follows:
G1:
5% or less of a nonsquamous or nonmorular solid growth pattern
G2:
6% to 50% of a nonsquamous or nonmorular solid growth pattern
G3:
more than 50% of a nonsquamous or nonmorular solid growth
pattern
Treatment
Treatment
largely depends on the stage of the disease -
Stage
I Endometrial Cancer -Patients with endometrial cancer who
have localized disease are usually curable by hysterectomy
(removal of uterus) and bilateral salpingo-oophorectomy (removal
of uterus with fallopian tubes and ovaries). Best results are
obtained with either of 2 standard treatments: hysterectomy or
hysterectomy and adjuvant radiation therapy (when deep invasion
of the myometrial muscle or grade 3 tumor with myometrial
invasion is present)
Stage
II Endometrial Cancer – In stage II, usually some form of
radiation therapy is used before sugery to decrease the size of
the tumor. Many combinations of preoperative intracavitary and
external-beam radiation therapy with hysterectomy and bilateral
salpingo-oophorectomy are used for treatment of stage II
endometrial cancer, with biopsy of the para-aortic nodes at the
time of surgery. Radical hysterectomy and pelvic lymphadenectomy
in selected cases.
Stage
III Endometrial Cancer -
In general, these patients are treated with surgery and
radiation therapy. Many of these patients may be inoperable if
the tumor extends to the pelvic wall, and in such cases,
radiation therapy should be used. Usually a combination of
intracavitary and external-beam radiation therapy is used.
Patients who are not candidates for either surgery or
irradiation may be treated with progestational agents.
Stage
IV Endometrial Cancer
- Treatment of stage IV endometrial cancer depends on the
site of metastatic disease and symptoms related to disease
sites. For large and bulky pelvic tumors, radiation therapy
consisting of a combination of intracavitary and external- beam
irradiation is used. When distant metastases, especially
pulmonary metastases, are present, hormonal therapy is indicated
and useful. The most common hormonal treatment has been
progestational agents, which produce good antitumor responses in
up to 15% to 30% of patients and significantly improves the
survival. Responses to hormones are correlated with the presence
and level of hormone receptors and the degree of tumor
differentiation. Standard progestational agents include
hydroxyprogesterone (Delalutin), medroxyprogesterone (Provera),
and megestrol (Megace).
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