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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