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Cancer Information

Diagnosis and treatment - Endometrial (uterine) Cancer

Diagnosis

  •  Physcial examination including pelvic examination by the doctor

  • 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.

  • Ultrasound of abdomen

  • 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.

  • 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

7. Adenoacanthoma

8. Uterine papillary serous (<10%).

9.  Mucinous (1%)

10. Clear cell (4%).

11. Squamous cell (< 1%)

12. Mixed (10%).

 13. Undifferentiated

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).