B20. Endometrial cancer; FIGO classification and therapy
FIGO classification
The International Federation of Gynaecology and Obstetrics (FIGO) classifications are similar to the TNM, but slightly different. FIGO classifications are preferred in gynaecology.
| Stage | Description |
|---|---|
| 0 | Carcinoma in situ |
| I | Tumour is localised to the corpus |
| II | Tumour reaches the cervix |
| III | Tumour infiltrates the neighbouring tissues (adnexa, vagina, lymph nodes) |
| IVa | Tumour infiltrates the bladder or rectum |
| IVb | Distant metastasis |
(There are substages of I, II, and III, but I’ve excluded them for simplicity)
Management
Unless contraindicated, surgical therapy should always be part of the therapy of endometrial cancer. If surgery is contraindicated, primary combined irradiation, brachytherapy, and teletherapy are necessary. Preoperative and/or postoperative irradiation may be performed as well.
Surgical therapy
Total laparoscopic hysterectomy with bilateral salpingo-oophorectomy (BSO) is the mainstay of surgical treatment. It is curative in early stages and improves prognosis in later stages. It also allows the proper surgical staging. Laparoscopy is preferred over laparotomy.
Pelvic and para-aortic lymph nodes are removed in case of middle risk and high risk stages, generally IIIc and above.
If presurgical evaluation shows possible spreading to the cervix (stage II), a radical hysterectomy is performed instead. Radical hysterectomy means the en bloc removal of the uterus, cervix, upper vagina, and parametrium.
Hormonal therapy
It was theorised that because Type I endometrial cancer is hormone sensitive that progestins may reduce tumour growth, but a large meta-analysis found no survival benefit for progestins. Hormonal therapy is therefore not routinely recommended but is an option for those with low-risk endometrial cancer who wish to preserve fertility.
Radiotherapy
Endometrial cancer is not particularly radiosensitive (especially compared with cervical cancer). Radiotherapy may be used for inoperable patients or for palliation. Both external beam radiotherapy and intravaginal brachytherapy may be used.
Chemotherapy
Chemotherapy is not frequently used in endometrial cancer. It may be used in recurring cancer or as adjuvant therapy. Paclitaxel + carboplatin is used.
Follow-up after treatment
- Physical examination
- Every 3 months in the first year
- Every 4 months in the second year
- Then less and less frequently until 1 time per year
- Imaging
- Chest x-ray
- MRI/CT/transvaginal ultrasound
- CA-125 detection