Adjuvant treatment of high-risk endometrial cancers
- Gini Fleming, MD
Gini Fleming, MD
- Professor of Medicine
- University of Chicago Medical Center
- Paul A DiSilvestro, MD
Paul A DiSilvestro, MD
- Program in Women's Oncology
- Women and Infants Hospital
- Alpert School of Medicine at Brown University
- Section Editors
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Director, Gynecologic Oncology
- University of Washington Medical Center
- Don S Dizon, MD, FACP
Don S Dizon, MD, FACP
- Section Editor – Gynecologic Oncology
- Head of Women's Cancers, Lifespan Cancer Institute
- Director of Medical Oncology, Rhode Island Hospital
- Associate Professor of Medicine, Warren Alpert Medical School of Brown University
Adenocarcinomas of the endometrium are the most common gynecologic malignancy in developed countries and the second most common in developing countries. Among the different histologic types of adenocarcinomas, grade 1 and 2 endometrioid uterine cancers have a favorable prognosis and typically present at an early stage. Other histologic types of uterine adenocarcinoma (eg, serous, clear cell) are associated with a poorer prognosis.
The American Joint Committee on Cancer (AJCC) and International Federation of Gynecology and Obstetrics (FIGO) combined staging system is used to designate cancer stage (table 1). In addition to stage, other pathologic factors are used to assign risk for recurrent or persistent disease into low, intermediate, and high risk.
Women with high-risk endometrial cancer have a poor prognosis following surgery alone. Therefore, adjuvant treatment is often administered, although the effect of any therapy following surgery on overall survival is unclear. This review will focus on treatment of high-risk endometrial cancer.
An overview of endometrial cancer, including clinical features and an approach to diagnosis, the approach to adjuvant treatment, and treatment of both low- and intermediate-risk endometrial cancer are discussed separately.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- DEFINITION OF HIGH RISK
- Uterine serous or clear cell carcinoma
- Deeply invasive grade 3 endometrioid carcinoma
- Stage III/IV disease
- High intermediate-risk disease
- TREATMENT APPROACH
- Early-stage disease
- - Noninvasive stage IA disease
- - Invasive stage IA, IB, or II disease
- Stage III disease
- - Addition of radiation for high risk of local relapse
- - Timing of pelvic radiation with chemotherapy
- Stage IV disease
- CHOICE OF CHEMOTHERAPY REGIMEN
- SPECIAL CONSIDERATIONS
- Older women
- Obese women
- Is there a role for adjuvant endocrine therapy?
- POSTTREATMENT SURVEILLANCE
- SUMMARY AND RECOMMENDATIONS