Histologic Subtypes of Endometrial Cancer

■ Endometroid (ciliated adenocarcinoma)—75 to 80%

■ Papillary serous:

■ Poor prognosis

■ No history of elevated estrogen

■ More common in blacks

■ Acts like ovarian cancer

■ Sarcomas (covered below)

STAGING OF ENDOMETRIAL CANCER

Staging is determined by the extent of the tumor. Therefore, staging must be accomplished surgically, not clinically, so the tumor can be visualized. This is always the first step in treatment.

I—only uterine involvement

IA—limited to endometrium

IB—invasion < one half of myometrium

IC—invasion > one half of myometrium

90% 5-year survival

II—cervical involvement

IIA—endocervical glands only IIB—invasion of cervical stroma

70% 5-year survival

III—local spread

IIIA—invasion of serosa and/or adnexa, and/or positive peritoneal cytology IIIB—invasion of vagina IIIC—mets to pelvic/para-aortic lymph nodes

40% 5-year survival

IV—distant spread

IVA—invasion of bladder and/or bowel IVB—distant invasion, including intraabdominal and/or inguinal lymph nodes

10% 5-year survival

GRADING

Grading is determined by the tumor histology: GI Well differentiated—< 5% solid pattern GII Moderately differentiated—5 to 50% solid pattern GIII Poorly differentiated—> 50% solid pattern

Grade is the most important prognostic indicator in endometrial cancer.

TREATMENT

Side effects:

Doxyrubicin—cardiotoxicity Cisplatin—nephrotoxicity

Basic treatment for all stages (surgical staging is always the first step):

■ Total abdominal hysterectomy (TAH)

■ Bilateral salpingo-oophorectomy (BSO)

■ Nodal sampling

■ Peritoneal washings

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