FEBRUARY 2019 ISSUE - Digital Edition

location of pelvic SLN being medial
to the external iliac, ventral to the
hypogastric, or in the superior part of
the obturator region. Occasionally the
lymphatic trunks do not cross over
the obliterated umbilical and move
upwards following the mesoureter and
seen in the common iliac presacral
region also. Considering the low
volume nodal metastasis ultra-staging
is recommended to detect the
disease. A side-specific nodal
dissection should be performed in
cases of failed mapping and any
suspicious or grossly enlarged nodes
should be removed regardless of
mapping.
SLN mapping should be undertaken
for the surgical staging of uterineconfined
disease with no obvious
factors, stage 1 can be further subdivided
into three risk categories. This
stratification is useful to plan adjuvant
therapy.
Adjuvant treatment according to
FIGO Stage and Grade of tumour
Radiotherapy plays an important role
in the management of endometrial
cancer.
STAGE I A
G1–G2: Observation
The risk of pelvic node positivity is
as low as 50%, LVSI, lymph
node metastasis and tumour diameter
>2 cm. Based on the presence of these
RISK STRATIFICATION OF
ENDOMETRIAL CARCINOMA
Low risk
Intermediate
risk
High risk
IB G3: external beam radiation therapy
(EBRT) and vaginal brachytherapy
STAGE II
Stage 1A (G1,2),
endometrioid disease
Stage 1A (G 3),
endometrioid type,
stage 1B (G1,2),
endometrioid type
Stage 1B (G3),
endometrioid type
All stages, nonendometrioid
type
Surgical treatment
Radical hysterectomy with bilateral
salpingo-oophorectomy and bilateral
pelvic ± para-aortic lymphadenectomy
When surgery is not feasible due to
medical contraindications (in ~5%–10%
of patients), or because of irresectable
disease, external beam radiation
therapy with or without intracavitary
brachytherapy can be considered.
Surgical treatment
Maximal surgical cytoreduction is
indicated in patients with a good
performance status and resectable
tumour.
STAGE III B
Vaginal involvement is usually treated
with a combination of external radiation
and intracavitary / interstitial radiation,
tailored according to the disease extent.
Adjuvant treatment
Chemotherapy
If positive nodes are detected
concurrent chemoradiotherapy
consisting of EBRT with platinum and
taxane based chemotherapy can be
considered. If paraaortic nodes are
involved, extended field radiation
should be considered.
STAGE IV
Systemic therapy + pelvic radiotherapy
If positive nodes are detected,
radiotherapy can be considered.
Recurrent endometrial cancer
Recurrent endometrial cancer is
treatable but not curable unless it is
confined to the vaginal cuff or pelvis.
Widely metastatic recurrence carries
poor prognosis. The treatment for
84 / FUTURE MEDICINE / FEBRUARY 2019