Download PDF
Geburtshilfe Frauenheilkd 2016; 76(02): 170-175
DOI: 10.1055/s-0035-1558230
Review
GebFra Science
Georg Thieme Verlag KG Stuttgart · New York

Current Issues in the Diagnosis and Treatment of Endometrial Carcinoma

Aktuelle Aspekte zur Diagnostik und Therapie des Endometriumkarzinoms
J. Stubert
Universitätsfrauenklinik und Poliklinik Rostock, Rostock
,
B. Gerber
Universitätsfrauenklinik und Poliklinik Rostock, Rostock
› Author Affiliations
Further Information

Publication History

received 02 August 2015
revised 15 September 2015

accepted 17 September 2015

Publication Date:
29 February 2016 (online)

Also available at
   Permissions and Reprints

Abstract

Endometrial carcinoma is the most common carcinoma of the female genital tract. Its most important clinical sign is postmenopausal bleeding. An endometrial biopsy is essential for diagnosis. Treatment decisions are governed by tumour risk assessment and patient comorbidity, which is often present. Pelvic and paraaortic lymph node dissection is unnecessary in low risk cases (definition: pT1 a, G1/2) and adjuvant radiotherapy and systemic treatments are usually avoidable. Treatment of high-risk patients (G3 and/or pT1b) and palliative cases is difficult and not well standardised. New molecular-based subtype classification may help treatment decision making in future.

Zusammenfassung

Das Endometriumkarzinom ist das häufigste Karzinom des weiblichen Genitales. Führendes klinisches Zeichen ist die postmenopausale Blutung. Für die Diagnosestellung ist immer eine Endometriumbiopsie notwendig. Die Therapieentscheidung hängt von der Risikoeinschätzung des Karzinoms und der häufig vorliegenden Komorbidität ab. In Fällen mit niedrigem Risiko (Definition: pT1 a, G1/2) ist eine pelvine und paraaortale Lymphknotendissketion unnötig. Eine adjuvante Bestrahlung und eine Systemtherapie sind zumeist vermeidbar. Die Behandlung von Hochrisikopatientinnen (G3 und/oder pT1b) und von Patientinnen in palliativer Situation ist schwierig und weniger gut standardisiert. Neue, molekular definierte Subtypen könnten hier zukünftig Therapieentscheidungen erleichtern.

Key words

endometrial carcinoma - paraaortic lymph node dissection - endometrial thickness - ultrasound - postmenopausal bleeding

Schlüsselwörter

Endometriumkarzinom - paraaortale Lymphknotendissektion - Endometriumdicke - Ultraschall - postmenopausale Blutung

Supporting Information

 

  • References

  • 1 Robert Koch-Institut, Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V., Hrsg. Krebs in Deutschland 2009/2010. 9. Ausgabe. Berlin: 2013
    Google Scholar
  • 2 Zuber TJ. Endometrial biopsy. Am Fam Physician 2001; 63: 1131-1135 1137–1141
    PubMedGoogle Scholar
  • 3 Timmermans A, Opmeer BC, Khan KS et al. Endometrial thickness measurement for detecting endometrial cancer in women with postmenopausal bleeding: a systematic review and meta-analysis. Obstet Gynecol 2010; 116: 160-167
    CrossrefPubMedGoogle Scholar
  • 4 AGO-Kommission Uterus. Empfehlungen für die Diagnostik und Therapie des Endometriumkarzinoms. April 2015.. Online: http://www.ago-online.de/fileadmin/downloads/leitlinien/uterus/empfehlungen_diagnostik_therapie_EC.pdf last access: 02.08.2015
    PubMedGoogle Scholar
  • 5 Jacobs I, Gentry-Maharaj A, Burnell M et al. Sensitivity of transvaginal ultrasound screening for endometrial cancer in postmenopausal women: a case-control study within the UKCTOCS cohort. Lancet Oncol 2011; 12: 38-48
    CrossrefPubMedGoogle Scholar
  • 6 Vergote I, Amant F, Timmerman D. Should we screen for endometrial cancer?. Lancet Oncol 2011; 12: 4-5
    CrossrefPubMedGoogle Scholar
  • 7 Gerber B, Krause A, Muller H et al. Ultrasonographic detection of asymptomatic endometrial cancer in postmenopausal patients offers no prognostic advantage over symptomatic disease discovered by uterine bleeding. Eur J Cancer 2001; 37: 64-71
    CrossrefPubMedGoogle Scholar
  • 8 Barak F, Kalichman L, Gdalevich M et al. The influence of early diagnosis of endometrioid endometrial cancer on disease stage and survival. Arch Gynecol Obstet 2013; 288: 1361-1364
    CrossrefPubMedGoogle Scholar
  • 9 Seebacher V, Schmid M, Polterauer S et al. The presence of postmenopausal bleeding as prognostic parameter in patients with endometrial cancer: a retrospective multi-center study. BMC Cancer 2009; 9: 460
    CrossrefPubMedGoogle Scholar
  • 10 Horwitz RI, Feinstein AR, Horwitz SM et al. Necropsy diagnosis of endometrial cancer and detection-bias in case/control studies. Lancet 1981; 2: 66-68
    PubMedGoogle Scholar
  • 11 Gerber B, Krause A, Muller H et al. Effects of adjuvant tamoxifen on the endometrium in postmenopausal women with breast cancer: a prospective long-term study using transvaginal ultrasound. J Clin Oncol 2000; 18: 3464-3470
    PubMedGoogle Scholar
  • 12 Steinke V, Engel C, Buttner R et al. Hereditary nonpolyposis colorectal cancer (HNPCC)/Lynch syndrome. Dtsch Arztebl Int 2013; 110: 32-38
    PubMedGoogle Scholar
  • 13 Uterine Neoplasms – NCCN Clinical Practice Guidelines in Oncology. Version 2.2015. 2015.. Online: https://www.nccn.org/store/login/login.aspx?ReturnURL=http://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf last access: 02.08.2015
    PubMedGoogle Scholar
  • 14 Emons G, Beckmann MW, Schmidt D et al. New WHO classification of endometrial hyperplasias. Geburtsh Frauenheilk 2015; 75: 135-136
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Kurman RJ, Kaminski PF, Norris HJ. The behavior of endometrial hyperplasia. A long-term study of “untreated” hyperplasia in 170 patients. Cancer 1985; 56: 403-412
    CrossrefPubMedGoogle Scholar
  • 16 Lacey jr. JV, Sherman ME, Rush BB et al. Absolute risk of endometrial carcinoma during 20-year follow-up among women with endometrial hyperplasia. J Clin Oncol 2010; 28: 788-792
    CrossrefPubMedGoogle Scholar
  • 17 Trimble CL, Kauderer J, Zaino R et al. Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia: a Gynecologic Oncology Group study. Cancer 2006; 106: 812-819
    CrossrefPubMedGoogle Scholar
  • 18 Suh-Burgmann E, Hung YY, Armstrong MA. Complex atypical endometrial hyperplasia: the risk of unrecognized adenocarcinoma and value of preoperative dilation and curettage. Obstet Gynecol 2009; 114: 523-529
    CrossrefPubMedGoogle Scholar
  • 19 Gallos ID, Krishan P, Shehmar M et al. LNG-IUS versus oral progestogen treatment for endometrial hyperplasia: a long-term comparative cohort study. Hum Reprod 2013; 28: 2966-2971
    CrossrefPubMedGoogle Scholar
  • 20 Dolapcioglu K, Boz A, Baloglu A. The efficacy of intrauterine versus oral progestin for the treatment of endometrial hyperplasia. A prospective randomized comparative study. Clin Exp Obstet Gynecol 2013; 40: 122-126
    PubMedGoogle Scholar
  • 21 Denschlag D, Ulrich U, Emons G. The diagnosis and treatment of endometrial cancer: progress and controversies. Dtsch Arztebl Int 2010; 108: 571-577
    PubMedGoogle Scholar
  • 22 Gunderson CC, Fader AN, Carson KA et al. Oncologic and reproductive outcomes with progestin therapy in women with endometrial hyperplasia and grade 1 adenocarcinoma: a systematic review. Gynecol Oncol 2012; 125: 477-482
    CrossrefPubMedGoogle Scholar
  • 23 Gallos ID, Yap J, Rajkhowa M et al. Regression, relapse, and live birth rates with fertility-sparing therapy for endometrial cancer and atypical complex endometrial hyperplasia: a systematic review and metaanalysis. Am J Obstet Gynecol 2012; 207: 266.e1-266.e12
    CrossrefPubMedGoogle Scholar
  • 24 Shan W, Wang C, Zhang Z et al. Conservative therapy with metformin plus megestrol acetate for endometrial atypical hyperplasia. J Gynecol Oncol 2014; 25: 214-220
    CrossrefPubMedGoogle Scholar
  • 25 Orbo A, Vereide A, Arnes M et al. Levonorgestrel-impregnated intrauterine device as treatment for endometrial hyperplasia: a national multicentre randomised trial. BJOG 2014; 121: 477-486
    CrossrefPubMedGoogle Scholar
  • 26 Gallos ID, Shehmar M, Thangaratinam S et al. Oral progestogens vs. levonorgestrel-releasing intrauterine system for endometrial hyperplasia: a systematic review and metaanalysis. Am J Obstet Gynecol 2010; 203: 547.e1-547.e10
    CrossrefPubMedGoogle Scholar
  • 27 Murali R, Soslow RA, Weigelt B. Classification of endometrial carcinoma: more than two types. Lancet Oncol 2014; 15: e268-e278
    CrossrefPubMedGoogle Scholar
  • 28 Cancer Genome Atlas Research Network. Kandoth C, Schultz N et al. Integrated genomic characterization of endometrial carcinoma. Nature 2013; 497: 67-73
    CrossrefPubMedGoogle Scholar
  • 29 McDermott DF, Atkins MB. PD-1 as a potential target in cancer therapy. Cancer Med 2013; 2: 662-673
    PubMedGoogle Scholar
  • 30 Le DT, Uram JN, Wang H et al. PD-1 blockade in tumors with mismatch-repair deficiency. N Engl J Med 2015; 372: 2509-2520
    CrossrefPubMedGoogle Scholar
  • 31 Milam MR, Java J, Walker JL et al. Nodal metastasis risk in endometrioid endometrial cancer. Obstet Gynecol 2012; 119: 286-292
    CrossrefPubMedGoogle Scholar
  • 32 Benedetti Panici P, Basile S, Maneschi F et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst 2008; 100: 1707-1716
    CrossrefPubMedGoogle Scholar
  • 33 ASTEC study group. Kitchener H, Swart AM et al. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet 2009; 373: 125-136
    CrossrefPubMedGoogle Scholar
  • 34 Todo Y, Kato H, Kaneuchi M et al. Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet 2010; 375: 1165-1172
    CrossrefPubMedGoogle Scholar
  • 35 Dowdy SC, Borah BJ, Bakkum-Gamez JN et al. Prospective assessment of survival, morbidity, and cost associated with lymphadenectomy in low-risk endometrial cancer. Gynecol Oncol 2012; 127: 5-10
    CrossrefPubMedGoogle Scholar
  • 36 Bell JG, Patterson DM, Klima J et al. Outcomes of patients with low-risk endometrial cancer surgically staged without lymphadenectomy based on intra-operative evaluation. Gynecol Oncol 2014; 134: 505-509
    CrossrefPubMedGoogle Scholar
  • 37 Walker JL, Piedmonte MR, Spirtos NM et al. Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group LAP2 Study. J Clin Oncol 2012; 30: 695-700
    CrossrefPubMedGoogle Scholar
  • 38 Lelle RJ, Morley GW, Peters WA. The role of vaginal hysterectomy in the treatment of endometrial carcinoma. Int J Gynecol Cancer 1994; 4: 342-347
    CrossrefPubMedGoogle Scholar
  • 39 Watanabe Y, Satou T, Nakai H et al. Evaluation of parametrial spread in endometrial carcinoma. Obstet Gynecol 2010; 116: 1027-1034
    CrossrefPubMedGoogle Scholar
  • 40 Kong A, Johnson N, Kitchener HC et al. Adjuvant radiotherapy for stage I endometrial cancer: an updated Cochrane systematic review and meta-analysis. J Natl Cancer Inst 2012; 104: 1625-1634
    CrossrefPubMedGoogle Scholar
  • 41 Onsrud M, Cvancarova M, Hellebust TP et al. Long-term outcomes after pelvic radiation for early-stage endometrial cancer. J Clin Oncol 2013; 31: 3951-3956
    CrossrefPubMedGoogle Scholar
  • 42 Nout RA, Smit VT, Putter H et al. Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial. Lancet 2010; 375: 816-823
    CrossrefPubMedGoogle Scholar
  • 43 Sorbe B, Nordstrom B, Maenpaa J et al. Intravaginal brachytherapy in FIGO stage I low-risk endometrial cancer: a controlled randomized study. Int J Gynecol Cancer 2009; 19: 873-878
    CrossrefPubMedGoogle Scholar
  • 44 Pectasides D, Pectasides E, Economopoulos T. Systemic therapy in metastatic or recurrent endometrial cancer. Cancer Treat Rev 2007; 33: 177-190
    CrossrefPubMedGoogle Scholar
  • 45 Johnson N, Bryant A, Miles T et al. Adjuvant chemotherapy for endometrial cancer after hysterectomy. Cochrane Database Syst Rev 2011; DOI: 10.1002/14651858.CD003175.pub2.
    PubMedGoogle Scholar
  • 46 Goldfinger M, Diaz I, Muggia F. Systemic treatment of endometrial cancer: what is doxorubicinʼs role?. J Clin Oncol 2014; 32: 2181-2182
    CrossrefPubMedGoogle Scholar
  • 47 Carlson MJ, Thiel KW, Leslie KK. Past, present, and future of hormonal therapy in recurrent endometrial cancer. Int J Womens Health 2014; 6: 429-435
    PubMedGoogle Scholar
  • 48 Gurumurthy M, Somoye G, Cairns M et al. An update on the management of uterine carcinosarcoma. Obstet Gynecol Surv 2011; 66: 710-716
    CrossrefPubMedGoogle Scholar
  • 49 Galaal K, van der Heijden E, Godfrey K et al. Adjuvant radiotherapy and/or chemotherapy after surgery for uterine carcinosarcoma. Cochrane Database Syst Rev 2013; (2) CD006812
    PubMedGoogle Scholar