Treatment of Carcinoma Endometrium

-Deepak Guru

Stage 0

Endometrial Hyperplasia

In younger women

• Progestogen therapy.

• Rx:

Medroxyprogesterone acetate (30-40 mg daily) X 6-12 months.

OR

Norethisterone 10 mg daily.

In elderly women- Total hysterectomy with removal of tubes and ovaries.

-Transcervical resection- CONTRAINDICATED.

Stage I- Cancer confined to Corpus Uteri.- IA- Tumour limited to endometrium.

- IB- Half or less than half myometrial thickness involved.

- IC- More than half myometrial thickness involved.

Surgery- Staging

- Abdominal Hysterectomy

- Bilateral salpingo-oopherectomy

- Omentectomy

- Pelvic and para-aortic lymph node sampling.

Surgery- Peritoneal washings: subdiaphragmatic area,

paracolic gutters and pelvis, for cytology.

- Open uterus and assess for tumor size, myometrial invasion and cervical extension. Frozen section preferred.

Stage IB and IC- Post operative pelvic radiotherapy.

- 4000-5000 cGy over 5-6 weeks.

- Vaginal vault radiotherapy.

Stage II- Tumour involves cervix but does not extend

beyond uterus.

- Brachytherapy followed 1 to 6 weeks later by Surgery and External Radiotherapy.

- Alternately, Wertheim’s hysterectomy.

Stage III- Local and/or regional spread

- IIIA- serosa, adnexa, peritoneal spread.- IIIB- Vaginal metastasis.- IIIC- Para-aortic/ Pelvic Lymph nodes.

Stage III- INOPERABLE.

- Doxorubicin 60 mg per sq. meter- Cisplatin and Paclitaxel.- Medroxyprogesterone acetate.- Whole abdomen irradiation 3000 cGy with

Kidney shielding.- 1500 cGy and 2000 cGy para-aortic nodes and

pelvic irradiation.

Stage IV- Tumour widespread.

- Palliative radiotherapy, chemotherapy and progestrogen may prolong life.

- Progestrogens:

MDPA 1g weekly or 200 mg OD.

or

Norethisterone 1g IM weekly.

- Tamoxifen 10 mg BD reduces oestrogen receptors.

Recurrent growth- Vaginal vault, Lateral pelvic wall, lymph

nodes, lungs, liver, brain, bones.

- Tamoxifen 20-40 mg daily.

5-year survival rate

Stage Overall survival rate (%)

I >90

II 65-80

III 35-45

IV 5-20

Thank You!

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