Endometrial Cancer Treatment Protocols
Treatment protocols for endometrial cancer are provided below, including the following:
- General treatment recommendations
- Recommendations for limited, metastatic, recurrent, and high-risk disease
- Risk classifications
General treatment recommendations for endometrial cancer
See the list below:
- Endometrial cancer is treated primarily with surgery, including hysterectomy, bilateral salpingo-oophorectomy, abdominopelvic washings, lymph node evaluation; advanced disease patients may be treated with maximal surgical cytoreduction
- There is no general agreement as to what constitutes the best chemotherapy, as very few phase III studies have been done comparing different chemotherapy regimens
- There are no guidelines or recommendations for second- and third-line therapy
- Salvage agents such as paclitaxel may be an option for second-line therapy in patients who have disease recurrence even after first-line chemotherapy
- Participating in a phase II study is encouraged
Treatment recommendations for limited disease
See the list below:
- Generally stage I endometrial cancer limited to the uterus, the recommended treatment is surgery.
- Radiation therapy has proven to be effective and tolerated for patients that are not candidates for surgery whose disease is limited to the uterus.
- Patients with suspected or gross cervical involvement who are candidates for surgery should be recommended radical hysterectomy with bilateral salpingo-oophorectomy; cytology and dissection of pelvic and para-aortic lymph nodes and inoperable patients should be treated with radiation therapy (75-80Gy to point A).
- Patients with suspected extra uterine disease should be evaluated through imaging studies (MRI or CT) or lab tests (CA 125 levels); if negative results return, treat patients as for disease limited to the uterus.
- Patients with extrauterine pelvic disease should be treated with radiation therapy and brachytherapy with or without surgery and chemotherapy.
Risk classification for patients with endometrial cancer.
Patients with endometrial cancer can be stratified into treatment groups based upon the estimated risk of disease recurrence.
- Low risk: endometrioid cancers that are confined to the endometrium.
- Intermediate risk: disease confined to the uterus but invades the myometrium, or demonstrates occult cervical stromal invasion; includes some patients with stage IA disease, stage IB disease, and a subset of patients with stage II disease.
High risk: includes gross involvement of the cervix (a subset of stage II disease; stage III or IV disease, regardless of grade; papillary serous or clear cell uterine tumors.