Endometrial Cancer
Introduction
This is predominantly a disease of old women. Adenocarcinoma is the commonest histological type. Risk factors for endometrial carcinoma include obesity, diabetes, high fat diet, early age at menarche, nulliparity and late age at menopause, old age and use of tamoxifen.
Management: Surgery is the main stay of treatment in early stages of the disease
Stage IA
Management-Total abdominal hysterectomy and bilateral salpingoopherectomy (TAH + BSO)
Stage IB, IIA
Management-TAH + BSO with pelvic lymphnode dissection followed by Radiotherapy (45Gy or 30Gy of External beam radiotherapy)
Note: For inoperable disease stage llb – lVA, radiotherapy and or chemotherapy can be offered as neo-adjuvant prior to surgery
Signs and Symptoms
Diagnostic criteria
Abnormal vaginal bleeding in a postmenopausal female.
Investigation
• FBC, LFTs, urea, creatinine and Cancer
• Cancer Antigen 125 (CA 125)
• CXR, Abdominal and pelvic USS
• Abdominal–pelvic CT scan and/or pelvic MRI
• Endometrial biopsy to confirm the diagnosis
Staging: By FIGO or TNM
Treatment
-
Pharmacological
- Cytotoxic therapy for inoperable, metastatic or recurrent disease is given with palliative intent and responses are generally of short duration.
The most active drugs are the platinum agents, taxanes and anthraccyclines. Combined regimens recommended for high–risk disease, inoperable, recurrent or metastatic disease include:
• Doxorubicin 60 mg/m2 IV plus cisplatin 50 mg/m2 IV on day 1; repeat every 21days
OR
• Doxorubicin 45 mg/m2 IV plus cisplatin 50 mg/m2 IV on day 1 plus paclitaxel 160 mg/m2 over 3h on day 1; repeat every 3weeks.
OR
• Cisplatin 50 mg/m2 IV plus doxorubicin 50 mg/m2 IV on day 1; repeat every 3weeks
OR
• Doxorubicin 45 mg/m2 IV on day 2 plus cisplatin 50 mg/m2 IV on day 1 plus paclitaxel 160 mg/m2 IV over 3h on day 2 plus filgrastim 5 μg/kg SC on days 3 –12; regimen repeated every 21days
OR
• Carboplatin AUC 5–6 IV plus paclitaxel 175 mg/m2 IV over 3hours on day 1 every 3weeks
Note:
• All patients should be referred to a gynecologist for evaluation and surgical treatment • All surgical specimens should be sent to lab for further histopathology diagnosis and staging. • After surgery and histopathology report, all patients should be referred to cancer specialized center for further management and follow up.
-
Non-pharmacological
-
Prevention
Updated on,
5 Novemba 2020, 09:22:46
References
1.STG