Endometrial Cancer Staging and Treatment

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Endometrial Cancer FIGO Staging

Endometrial Cancer FIGO Staging is the most commonly used staging system for the disease. FIGO stands for International Federation of Gynecology and Obstetrics.

Read about Endometrial Cancer Risk Factors and Symptoms.

FIGO Stage IA

The primary tumor is limited to the endometrium or has invaded less than half of myometrium.

FIGO Stage IB

The primary tumor has invaded half or more of the myometrium. stage 1, invades myometrium

FIGO Stage II

The primary tumor is present only in the uterus and has extended up to the cervical connective tissue. stage 2 invades cervix

FIGO Stage IIIA

The cancer cells have spread to the outer surface of the uterus (serosa) or to the fallopian tube, ovary, round/broad ligament (adnexa). stage 3A invades ovary

FIGO Stage IIIB

The cancer cells have spread to the vagina or up to the parametrium. stage 3b, invades vagina or parametrium

FIGO Stage IIIC1

Cancer has spread to pelvic lymph nodes but not to the lymph nodes along the aorta or to distant body parts. stage 3c1, invades pelvic lymph nodes

FIGO Stage IIIC2

Cancer has spread to the lymph nodes along the aorta but not to the distant body parts. stage 3c2, invades para-aortic lymph nodes

FIGO Stage IVA

Cancer has spread up to the mucosa of the rectum or urinary bladder. stage 4a, invades bladder or bowel mucosa

FIGO Stage IVB

The cancer cells have spread to distant body parts such as distant lymph nodes, lungs, bones, liver, etc. stage 4b, metastasis to distant sites  

Endometrial Cancer FIGO Staging - stage I to stage IIIIb endometrial cancer figo staging - stage IIIc and stage IV

Investigations for Staging Endometrial Cancer

Transvaginal Ultrasound (TVUS)

transvaginal ultrasound

To examine the endometrium, fallopian tubes, ovaries, and other nearby structures for any abnormality. This test can detect any solid tumors (appear as a solid mass) or abnormal endometrial thickening that may indicate endometrial cancer. This test can also provide information regarding the location, extent of disease or invasion into the muscle layer (myometrium).

Hysteroscopy

hysteroscopy for endometrial cancer

In this technique, a tiny telescope-like device is inserted into the uterus through the vagina and cervix to closely examine the endometrium. This enables a doctor to determine any abnormal area(s) and to collect biopsy samples from such area(s) observed during the test.

Endometrial Biopsy

endometrial biopsy

Biopsy sample(s) from the endometrium is generally collected in case an abnormal area(s) is observed during the TVUS or hysteroscopy procedure. This can be removing a small amount of endometrial tissue via a thin tube inserted into the uterus through the cervix.

In case the collected biopsy sample is inadequate or patient is being considered for a fertility-sparing treatment, a dilation and curettage (D&C) can be performed. In D&C, the cervix is dilated and endometrial tissue is scraped from inside of the uterus using special instruments.

Imaging Tests

One or more of the belowmentioned imaging tests are required to stage the disease and assess response to treatment.

  • Computed tomography (CT) scan
  • Positron emission tomography (PET) scan
  • Magnetic resonance imaging (MRI) scan

Blood tests for tumor markers

Tumor markers are generally proteins or other substances that are produced by both normal cells and cancer cells. However, in the case of cancer, the level of these markers rises in the blood, urine, or other biological fluids, which can be detected by certain laboratory tests. Level of cancer antigen (CA)-125 has been reported to be elevated in many patients with endometrial cancer.

Endometrial Cancer Treatment

The endometrial cancer treatment depends on various factors including the type of endometrial cancer, stage of the disease, grade of the tumor, patient’s preference (for example, to retain fertility or not), performance status of the patient, along with other factors.

Non Metastatic Endometrial Cancer Treatment
Treatment for Non Metastatic Endometrial Cancer Cancer

FIGO STAGE I

In case of Stage I endometrial cancer, after hysterectomy, the patient may be kept on observation or may be given radiation therapy with/without chemotherapy depending on stage, grade and other risk factors.

FIGO STAGE II

In case of Stage II endometrial cancer, after hysterectomy, patient requires radiation therapy with/without chemotherapy in most cases.

FIGO STAGE III

In case of Stage III endometrial cancer, surgery (performed only if all cancer tissue can be removed) followed by chemotherapy and/or radiotherapy is considered as the standard treatment.

FIGO STAGE IV

In case of Stage IV endometrial cancer, hormone therapy or chemotherapy is generally considered as the standard treatment. Surgery and or radiotherapy may also be employed alongside hormone therapy or chemotherapy as palliative treatment to relieve symptoms.

metastatic endometrial cancer treatment

Surgery for Endometrial Cancer

endometrial cancer surgery treatment

Surgery is the first-line treatment for many early-stage and some advanced-stage endometrial cancers. There are mainly 2 aims of surgery in endometrial cancer: first is to stage the disease and second is to remove all possible cancerous tissue to treat the disease. 

Hysterectomy is commonly employed for the management of endometrial cancer. In a total hysterectomy, the entire uterus is removed keeping all other structures. In a radical hysterectomy, the uterus along with associated tissues like parametria, uterus ligaments, part of the vagina, pelvic lymph nodes, and fallopian tubes and ovaries are removed.

Role of Hormonal Therapy 

hormone replacement therapy

This treatment approach is based on the fact that most endometrial cancer cells grow under the influence of estrogen. Estrogen is predominately produced by the ovaries and a small amount is also produced by the fat tissue in females.

Depriving the endometrial cancer cells of the estrogen or by lowering the estrogen level in the blood cause their shrinkage or make them grow very slowly. Following are some common types of hormonal therapy used for the treatment of endometrial cancer:

Progestins: Drugs like medroxyprogesterone acetate and megestrol acetate are commonly used progestins which act similar to progesterone and inhibit estrogen to produce its eliciting effect on endometrial cancer cells.

Tamoxifen: Tamoxifen is a drug commonly used in breast cancer and can be used to treat advanced-stage endometrial cancer. It blocks the estrogen receptors in cancer cells and can act as a weak estrogen in other body tissues like bones.

Luteinizing hormone-releasing hormone agonists: These drugs (e.g. leuprolide, and goserelin) decrease the level of estrogen in the blood by acting on the pituitary gland which in turn signals to stop the production of estrogen from the ovaries. These drugs can be used alone or in combination with other hormonal drugs in pre-menopausal women.

Aromatase inhibitors (AIs): Aromatase is an enzyme that helps in the production of estrogen from fatty tissue. In post-menopausal women, fatty tissue is the main source of estrogen. Thus, AIs (e.g. letrozole, anastrozole, and exemestane) help in lowering estrogen levels in post-menopausal women and used for the treatment of endometrial cancer in such patients.

Role of Chemotherapy

Chemotherapy may be used for endometrial cancer treatment as a part of concurrent chemoradiation (chemotherapy given in combination with radiothrapy), adjuvant chemotherapy (chemotherapy after surgery) or palliative therapy (in patients with metastatic disease).

The chemotherapy drugs that are a part of endometrial cancer treatment regimens are-

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