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
- Professor of Gynecologic Oncology
- University of Washington
- Don S Dizon, MD, FACP
Don S Dizon, MD, FACP
- Section Editor – Gynecologic Oncology
- Clinical Co-Director, Gynecologic Oncology
- Founder and Director, The Oncology Sexual Health Clinic
- Massachusetts General Hospital Cancer Center
- Associate Professor of Medicine
- Harvard Medical School
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.
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- DEFINITION OF HIGH RISK
- Uterine serous or clear cell carcinoma
- Stage III disease
- High intermediate-risk disease
- TREATMENT APPROACH
- Serous carcinoma
- - Stage IA disease without myometrial invasion
- - Stage IA or IB disease
- - Stage II disease
- Clear cell carcinoma
- Stage III disease, regardless of histology
- Choice of chemotherapy regimen
- Timing of radiation with chemotherapy
- Is there a role for adjuvant endocrine therapy?
- CLINICAL TRIALS
- SPECIAL CONSIDERATIONS
- Newly diagnosed stage IV disease
- Older women
- Obese women
- POSTTREATMENT SURVEILLANCE
- SUMMARY AND RECOMMENDATIONS