2010, Number 6
PDF size: 148.14 Kb.
ABSTRACTIntroduction. Endometrial cancer (EC) is the second most common gynecologic malignancy worldwide in the peri and postmenopausal period. Most often for the endometrioid variety. In early clinical stages long-term survival is greater than 80%, while in advanced stages it is less than 50%. In our country there is not a standard management between institutions. GICOM collaborative group under the auspice of different institutions have made the following consensus in order to make recommendations for the management of patients with this type of neoplasm. Material and methods. The following recommendations were made by independent professionals in the field of Gynecologic Oncology, questions and statements were based on a comprehensive and systematic review of literature. It took place in the context of a meeting of four days in which a debate was held. These statements are the conclusions reached by agreement of the participant members. Results. Screening should be performed women at high risk (diabetics, family history of inherited colon cancer, Lynch S. type II). Endometrial thickness in postmenopausal patients is best evaluated by transvaginal US, a thickness greater than or equal to 5 mm must be evaluated. Women taking tamoxifen should be monitored using this method. Abnormal bleeding in the usual main symptom, all post menopausal women with vaginal bleeding should be evaluated. Diagnosis is made by histerescopy-guided biopsy. Magnetic resonance is the best image method as preoperative evaluation. Frozen section evaluates histologic grade, myometrial invasion, cervical and adnexal involvement. Total abdominal hysterectomy, bilateral salpingo oophorectomy, pelvic and para-aortic lymphadenectomy should be performed except in endometrial histology grades 1 and 2, less than 50% invasion of the myometrium without evidence of disease out of the uterus. Omentectomy should be done in histologies other than endometriod. Surgery should be always performed by a Gynecologic Oncologist or Surgical Oncologist, laparoscopy is an alternative, especially in patients with hypertension and diabetes for being less morbid. Adjuvant treatment after surgery includes radiation therapy to the pelvis, brachytherapy, and chemotherapy. Patients with Stages III and IV should have surgery with intention to achieve optimal cytoreduction because of the impact on survival (51 m vs. 14 m), the treatment of recurrence can be with surgery depending on the pattern of relapse, systemic chemotherapy or hormonal therapy. Follow-up of patients is basically clinical in a regular basis. Conclusions. Screening programme is only for high risk patients. Multidisciplinary treatment impacts on survival and local control of the disease, including surgery, radiation therapy and chemotherapy, hormonal treatment is reserved to selected cases of recurrence. This is the first attempt of a Mexican Collaborative Group in Gynecology to give recommendations is a special type of neoplasm.
World Health Organization. International Agency for Research on Cancer. Globocan 2005. Cancer incidence, mortality and prevalence worldwide.
Hecht JL, Mutter GL. Molecular and pathologic aspects of endometrial carcinogenesis. J Clin Oncol 2006; 24: 4783-91.
Yong WF, Cheung TH, Lo KW, et al. Identification of molecular markers and signaling pathway in endometrial cancer in Hong Kong Chinese women by genome-wide gene expression profiling. Oncogene 2007; 26: 1971-8.
Podsypanina K, Lee RT, Politics C, et al. An inhibitor of mTOR reduces neoplasia and normalizes p70/S6 kinase activity in pTen T mice. Proc Natl Acad Sci USA 2001; 98: 10320-5.
Grönross M, Salmi TA, Vuento MH, Jalava EA, Tyrkkö JE, Maatela JI, et al. Mass screening for endometrial cancer directed in risk groups of patients with diabetes and patients with hypertension. Cancer 1993; 71(4): 1279-82.
Smith RA, Cokkinides V, Brawley OW. Cancer screening in the United States, 2009: a review of current American Cancer Society Guidelines and issues in cancer screening. CA Cancer J Clin 2009; 59: 27-41.
Smith RA, Cokkinides V, Eyre HJ. American Cancer Society Guidelines for the Early Detection of Cancer, 2004. CA Cancer J Clin 2004; 54: 41-52.
Fisher B, Costantino JP, Redmond CK, Fisher ER, Wickerham DL, Cronin WM, Other NSABP contributors. Endometrial cancer in tamoxifen-treated breast cancer patients: findings from the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-14. J Natl Cancer Inst 1994; 86: 527-37.
Swerdlow AJ, Jones ME. Tamoxifen treatment for breast cancer and risk of endometrial cancer: a case-control study. J Natl Cancer Inst 2005; 97: 375-84.
Barakat RR, Wong G, Curtin JP, Vlamis V, Hoskins WJ. Weigel M, Friese K, et al. Measuring the thickness-is that all we have to do for sonographic assessment of endometrium in postmenopausal women? Ultrasound Obstet Gynecol 1995; 6: 97-102.
Gershenson DM, Mc Guire WP, Gore M, Quinn MA, Thomas G (Eds.). Gynecologic cancer: controversies in management. Cap 17. Philadelphia: Elsevier LTD; 2004, p. 241-48.
Ferguson SE, Soslow RA, Amsterdam A, Barakat RR. Comparison of uterine malignancies that develop during and following tamoxifen therapy. Gynecol Oncol 2006; 101: 322-26.
Brinton LA, Hoover RN. Estrogen replacement therapy and endometrial cancer risk: unresolved issues. The Endometrial Cancer Collaborative Group. Obstet Gynecol 1993; 81: 265-71.
Garuti G, Cellani F, Centinaio G, Sita G, Nalli G, Luerti M. Baseline endometrial assessment before tamoxifen for breast cancer in asymptomatic menopausal women. Gynecol Oncol 2005; 98(1): 63-7.
Gerber B, Krause A, Reimer T, Mylonas I, Makovitzky J, Kundt G, et al. Anastrozole versus tamoxifen treatment in postmenopausal women with endocrine-responsive breast cancer and tamoxifen-induced endometrial pathology. Clin Cancer Res 2006; 12(4): 1245-50.
De Michele A, Tropel AB, Berlin JA, Weber AL, Bunin GR, Turzo E, et al. Impact of raloxifene or tamoxifen use on endometrial cancer risk: a population-based case-control study. J Clin Oncol 2008; 26(25): 4151-59.
Bland AE, Calingaert B, Alvarez-Secord A, Lee PS, Valea FA, Berchuck A, et al. Relationship between tamoxifen use and high risk endometrial cancer histologic types. Gynecol Oncol 2009; 112(1): 150-54.
Solima E, Brusati V, Ditto A, Kusamura S, Martinelli F, Hanozet F, et al. Hysteroscopy in endometrial cancer: new methods to evaluate transtubal leakage of saline distensión medium. Am J Obstet Gynecol 2008; 198(2): 214.e1-214.e4.
Gerber B, Krause A, Müller H, Reimer T, Külz T, Kundt G, et al. Ultrasonographic detection of asyntomatic endometrial cancer in postmenopausal patients offers no prognostic advantage over syntomatic disease discovered by uterine bleeding. Eur J Cancer 2001; 37(1): 64-71.
Gull B, Carlsson SA, Karlsson B, Ylostalo P, Milsom I, Granberg S. Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding: is it always necessary to perform and endometrial biopsy? Am J Obstet Gynecol 2000; 182: 509-15.
Langer RD, Pierce JJ, O’Hanlan KA, Johnson SR, Espeland MA, Trabal JF, et al. Transvaginal ultrasonography compared with endometrial biopsy for the detection of endometrial disease. Postmenopausal Estrogen/Progestin Interventions Trial. N Engl J Med 1997; 337(25): 1792-98.
National Comprehensive Cancer Network [sede Web]. Fort Washington: NCCN Clinical practice guidelines in oncology; 2009. Uterine Neoplasms. V.I.2008 [48 pantallas]. Disponible en: www.nccn.org
Kinkel K, Kaji Y, Yu KK, Segal MR, Lu Y, Powell CB, et al. Radiologic staging in patients with endometrial cancer: a metaanalysis. Radiology 1999; 212(3): 711-18.
Ben-Shachar I, Pavelka J, Cohn DE, Copeland LJ, Ramirez N, Manolitsas T, et al. Surgical staging for patients presenting with grade 1 endometrial carcinoma. Obstet Gynecol 2005; 105(3): 487-93.
Savelli L, Ceccarini M, Ludovisi M, Fruscella E, De Iaco PA, Salizzoni E, et al. Preoperative local staging of endometrial cancer: transvaginal sonography vs. magnetic resonance imaging. Ultrasound Obstet Gynecol 2008; 31(5): 560-66.
Zerbe MJ, Bristow R, Grumbine FC, Montz FJ, KM. Inability of preoperative computed tomography scans to accurately predict the extent of myometrial invasion and extracorporal spread in endometrial cancer. Gynecol Oncol 2000; 78: 67-70.
Ortashi O, Jain S, Emannuel O, Henry R, Wood A, Evans J. Evaluation of the sensitivity, specificity, positive and negative predictive values of preoperative magnetic resonance imaging for staging endometrial cancer. A prospective study of 100 cases at the Dorset Cancer Centre. Eur J Obstet Gynecol Reprod Biol 2008; 137: 232-35.
Nagar H, Dobss S, McClelland R, Price J, McCluggage WG, Grey A. The diagnostic accuracy of magnetic resonance imaging in detecting cervical involvement in endometrial cancer. Gynecol Oncol 2006; 103: 431-34.
Chung HH, Kang SB, Cho JY, Kim JW, Park NH, Song YS, et al. Accuracy of MR imaging for the prediction of myometrial invasion of endometrial carcinoma. Gynecol Oncol 2007; 104: 654-59.
Matias-Guiu X. Endometrial neoplasia. In: Nucci M, Oliva E. Gynecologic Pathology. 1st Ed. USA: Churchill Livingstone; 2009, p. 233-59.
Tavassoli FA, Devilee P (Eds.). World Health Organization Classification of Tumors. Pathology and Genetics of Tumors of the Breast and Female Genital Organs. IARC Press: Lyon 2003.
Crum CP, Duska LR, Lee KR, Mutter GL. Adenocarcinoma, carcinosarcoma and other epithelial tumors of endometrium. In: Crum CP, Lee KR. Diagnostic gynecologic and obstetric pathology. 1st Ed. Philadelphia USA: Elsevier Saunders; 2006, p. 545-610.
Baker P, Oliva E. A practical approach intraoperative consultation in gynecological pathology. Int J Gynecol Pathol 2008; 3: 353-65.
Benedetti PP, Basile S, Maneschi F, Alberto Lissoni A, Signorelli M, Scambia G, et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst 2008; 100(23): 1707-116.
Egle D, Grissemann B, Zeimet AG, Muller-Holzner E, Marth C. Validation of intraoperative risk assessment on frozen section for surgical management of endometrial carcinoma. Gynecol Oncol 2008; 110: 286-92.
Selman TJ, Mann CH, Zamora J, Khan KS. A systematic review of tests for lymph node status in primary endometrial cancer. BMC Women’s Health 2008; 8: 8.
Leitao MM, Kehoe S, Barakat RR, Alektiar K, Gattoc LP, Rabbitt C, et al. Accuracy of preoperative endometrial sampling diagnosis of FIGO grade I endometrial adenocarcinoma. Gynecol Oncol 2008; 111: 244-48.
Hoekstra A, Singh DK, Garb M, Arekapudi S, Rademaker A, Lurain JR. Participation of the general gynecologist in surgical staging of endometrial cancer: analysis of cost and perioperative outcomes. Gynecol Oncol 2006; 103: 897-901.
Management of endometrial cancer. American College of Obstetrics and Gynecology, ACOG practice bulletin. Clinical management guidelines for Obstetrician-Gynecologists. Obstet Gynecol 2005; 65(2): 413-25.
Petereit DG. Complete surgical staging in endometrial cancer provides prognostic information only. Semin Radiat Oncol 2000; 10(1): 8-14.
Münstedt K, Grant P, Woenckhaus J, Roth G, Tinneberg HR. Cancer of the endometrium: current aspects of diagnostics and treatment. World J Surg Oncol 2004; 2: 24.
Imai M, Jobo T, Kuramoto H, Takahashi K, Konno R, et al. Is peritoneal cytology a prognostic factor of endometrial cancer confined to the uterus? Gynecol Oncol 2006; 103(1): 277-80.
Fujiwara H, Saga Y, Takahashi K, Ohwada M, Enomoto A, Konno R, et al. Omental metastases in clinical stage I endometrioid adenocarcinoma. Int J Gynecol Cancer 2008; 18(1): 165-67.
Nieto JJ, Gornall R, Toms E, Clarkson S, Hogston P, Woolas RP. Influence of omental biopsy on adjuvant treatment field in clinical stage I endometrial carcinoma. BJOG 2002; 109: 576-78.
Mariani A, Webb MJ, Keeney GL, Haddock MG, Calori G, Podratz KC. Low-risk corpus cancer: is lymphadenectomy or radiotherapy necessary? Am J Obstet Gynecol 2000; 182(6): 1506-19.
Malzoni M, Tinelli R, Cosentino F, Perone C, Rasile M, Iuzzolino D, et al. Total laparoscopic hysterectomy versus abdominal hysterectomy with lymphadenectomy for early-stage endometrial cancer: a prospective randomized study. Gynecol Oncol 2009; 112(1): 126-33.
ASTEC/EN.5 Study Group, Blake P, Swart AM, Orton J, Kitchener H, Whelan T, Lukka H, et al. Adjuvant external beam radiotherapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomised trials): pooled trial results, systematic review, and meta-analysis. Lancet 2009; 373(9658): 137-146, 192.
Kalogiannidis I, Lambrechts S, Amant F, Neven P, Van Gorp T, Vergote I. Laparoscopy-assisted vaginal hysterectomy compared with abdominal hysterectomy in clinical stage I endometrial cancer: safety, recurrence, and long-term outcome. Am J Obstet Gynecol 2007; 196(3): 248.e1-e8.
Serachiolli R, Mabrouk M, Manuzzi L, Savelli L, Venturoli S. Role of laparoscopic hysterectomy in the management of endometrial cancer. Curr Opin Obstet Gynecol 2008; 20: 337-44.
Kuoppala T, Tomás E, Heinonen PK. Clinical outcome and complications of laparoscopic surgery compared with traditional surgery in women with endometrial cancer. Arch Gynecol Obstet 2004; 270(1): 25-30.
Magrina JF, Weaver AL. Laparoscopic treatment of endometrial cancer: five-year recurrence and survival rates. Eur J Gynaecol Oncol 2004; 25(4): 439-41.
Maffuz-Aziz A, Cortés-Martínez G, Delgado-Ramírez R, Escudero- de los Ríos P, Quijano-Castro F, López-Hernández D. Histerectomía laparoscópica en el tratamiento quirúrgico de enfermedades ginecológicas malignas y premalignas. Cir Ciruj 2005; 73: 107-112, 116.
Holub Z, Jabor A, Bartos P, Hendl J, Urbánek S. Laparoscopic surgery in women with endometrial cancer: the learning curve. Eur J Obstet Gynecol Reprod Biol 2003; 107: 195-200.
Creasman W. Revised FIGO staging for carcinoma of the endometrium. Int J Gynaecol Obstet 2009; 105(2): 109.
Greene FL, Page DL (Eds.). AJCC cancer staging handbook. 6th Ed. New York: Springer-Verlag; 2002, p. 299-06.
Susumu N, Sagae S, Udagawa Y, Niwa K, Kuramoto H, Satoh S et al. Japanese Gynecologic Oncology Group. Ramdomized phase III trial of pelvic radiotherapy versus cisplatin-based combined chemotherapy in patients with intermediate - and high-risk endometrial cancer: A Japanese Gynecologic Oncology Group study. Gynecol Oncol 2008; 108: 226-33.
Maggi R, Lissoni A, Spina F, Melpignano M, Zola P, Favalli G, et al. Adjuvant chemotherapy versus radiotherapy in high-risk endometrial carcinoma: results of a randomized trial. Br J Cancer 2006; 95: 266-71.
Kong A, Powell M, Blake P. The role of postoperative radiotherapy in carcinoma of the endometrium. Clin Oncol (R Coll Radiol) 2008; 20(6): 457-62.
Croog VJ, Abu-Rustum NR, Barakat RR, Alektiar KM. Adjuvant radiation for early stage endometrial cancer with lymphovascular invasion. Gynecol Oncol 2008; 111(1): 49-54.
Gaducci A, Cosio S, Genazzani AR. Old and new perspectives in the pharmacological treatment of advanced or recurrent endometrial cancer: hormonal therapy, chemotherapy and molecularly targeted therapies. Crit Rev Oncol/Hematol 2006; 58: 242-56.
Aoki Y, Watanabe M, Amikura T, Obata H, Sekine M, Yahata T, et al. Adjuvant chemotherapy as treatment of high-risk stage I and II endometrial cancer. Gynecol Oncol 2004; 94(2): 333-39.
Kumagai S, Sugiyama T, Honda S, Nishida T, Kamura T. Postoperative adjuvant chemotherapy with cisplatin, doxorubicin and cyclophosphamide in patients with endometrial cancer at highrisk of recurrence. Proc Am Soc Clin Oncol 2001; 20: 2484.
Greven K, Winter K, Underhill K, Fontenesci J, Cooper J, Burke T. Final analysis of RTOG 9708: adjuvant postoperative irradiation combined with cisplatin/paclitaxel chemotherapy following surgery for patients with high-risk endometrial cancer. Gynecol Oncol 2006; 103(1): 155-59.
Hogberg T, Rosenberg P, Kristensen G, de Oliveira CF, de Pont Christensen R, Sorbe B. A randomized phase-III study on adjuvant treatment with radiation (RT) ± chemotherapy (CT) in early-stage high-risk endometrial cancer (NSGO-EC-9501/ EORTC 55991). J Clin Oncol 2007; 25(18S): 5503.
Hogberg T. Adjuvant chemotherapy in endometrial carcinoma. Overview of randomized trials. Clin Oncol 2008; 20: 463-69.
Thomas MB, Mariani A, Cliby WA, Keeney GL, Podratz KC, Dowdy SC. Role of cytoreduction in stage III and IV uterine papillary serous carcinoma. Gynecol Oncol 2007; 107(2): 190-93.
Bruzzone M, Miglietta L, Franzone P, Gadducci A, Boccardo F. Combined treatment with chemotherapy and radioteraphy in high-risk FIGO stage III-IV endometrial cancer patients. Gynecol Oncol 2004; 93: 345-52.
Randall ME, Filiaci VL, Muss H, Spirtos NM, Robert S, Mannel Fowler J, et al. Randomized Phase III Trial of Whole-Abdominal Irradiation Versus Doxorubicin and Cisplatin Chemotherapy in Advanced Endometrial Carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol 2006; 24(1): 36-44.
Fleming GF, Brunetto VL, Cella D, Look KY, Reid GC, Munkarah AR, et al. Phase III trial of doxorubicin plus cisplatin with or without paclitaxel plus filgrastim in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol 2004; 22(11): 2159-66.
Hoskins PJ, Swenerton KD, Pike JA, Wong F, Lim P, Acquino- Parsons C, et al. Paclitaxel and carboplatin, alone or with irradiation, in advanced or recurrent endometrial cancer: a phase II study. J Clin Oncol 2001; 19(20): 4048-53.
Morris M, Alvarez RD, Kinney WK, Wilson TO. Treatment of recurrent adenocarcinoma of the endometrium with pelvic exenteration. Gynecol Oncol 1996; 60(2): 288-91.
Thigpen JT, Brady MF, Homesley HD, Malfetano J, DuBeshter B, Burger RA, et al. Phase III trial of doxorubicin with or without cisplatin in advanced endometrial carcinoma: a gynecologic oncology group study. J Clin Oncol 2004; 22(19): 3902-08.
Van Wijk FH, van der Burg ME, Burger CW, Vergote I, van Doorn HC. Management of recurrent endometrioid endometrial carcinoma: an overview. Int J Gynecol Cancer 2009; 19(3): 314-20.
Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, et al. Grading quality of evidence and strength of recommendations. BMJ 2004; 328: 1490.