How can endometrial cancer be treated?

Objectives:

To clarify the effect of postoperative (adjuvant) external-beam pelvic radiotherapy (EBRT) for different grades of early endometrial cancer.

Search Strategy:

Meta-analysis of data from randomised trials stratified by histological risk factors supported by cohort studies.

Selection Criteria:

Cochrane methodology. DATA: Seven randomised trials were identified. Five were eligible for meta-analysis. Homogeneity was confirmed (I2 < 25%).

Main Outcome Measures:

Survival, site of recurrence and added complications.

Main Results:

EBRT after hysterectomy for low-risk disease increases the odds of death (OR for overall survival 0.71; 95% CI 0.52-0.96). EBRT does not appear to alter survival for intermediate-risk cancers (stage ICG1/2 and IBG3) (OR 0.97; 95% CI 0.69-1.35). In contrast, EBRT offers a significant disease-free survival advantage for high-risk cancer (OR 1.76; 95% CI 1.07-2.89). The survival advantage benefits one in ten women. The definition of high risk is variable across studies but focuses on ICG3 (deeply invasive, poorly differentiated) tumours. Pelvic EBRT reduces the risk of pelvic recurrent disease in all types of invasive endometrial cancer (OR 0.27; 95% CI 0.16-0.44), but local recurrence may respond to salvage treatment. The risk of distant metastasis appears to be increased significantly by prophylactic EBRT (OR 1.58; 95% CI 1.07-2.35), but this might be because pelvic relapse in untreated women alters reporting of metastatic disease. AUTHORS'

Conclusions:

Adjuvant EBRT should not be used for low- (IA, IBG1) or intermediate-risk (IBG2) cancer, but it is associated with a 10% survival advantage for high-risk (stage ICG3) endometrial cancer. This challenges the role of a staging lymphadenectomy.

Please click on the required question.

• 1 What is cancer (malignancy)
• 2 What is meant by cancer staging?
• 3 How prevalent is cancer?
• 4 How prevalent are womens' cancers?
• 5 What causes cancer?
• 6 Is cancer a hereditary condition?
• 7 How can gynaecological cancer present?
• 8 How can we reduce the risks of the womens' cancers?

  Reducing the Risks of Womens' Cancers.

• 9 What are screening tests?
• 10 What are the reactions to a diagnosis of cancer?
• 11 Is there a place for counselling when cancer is diagnosed?
• 12 Can personality alter the prognosis?
• 13 Is the incidence of deaths from the female cancers changing?
• 14 Is there a place for a holistic approach to cancer?

   

  Cancer of the Cervix.

• 15 How prevalent is cervical cancer?
• 16 What causes cervical cancer?
• 17 How long an interval should there be between cervical screening (smear) (PAP) tests?
• 18 Is there any evidence that cervical screening can reduce the incidence of cervical cancer?
• 19 Will pre-malignant changes of the cervix invariably lead to cancer?

  Endometrial Cancer (Uterus)

• 20 What causes endometrial cancer?
• 21 Are there screening tests for endometrial cancer?
• 22 How does endometrial cancer present?
• 22a How can endometrial cancer be prevented?
• 22b How can endometrial cancer be treated?

  Cancer of the Ovary.

• 23 How does ovarian cancer present?
• 24 How prevalent is ovarian cancer?
• 25 What are tumour markers?
• 26 Can we screen for ovarian cancer?
• 27 What is the relationship between infertility and ovarian cancer?
• 28 Can treatment of infertility increase the risk of ovarian cancer?
• 29 What is the relationship between oral contraception and cancer?
• 30 Can ovarian cancer be prevented?
• 31 I use talcum power. Could this increase my risk of developing ovarian cancer?

   

  The Treatment Of Womens' Cancers

• 32 Can we predict the course of a cancer?
• 33 What treatment options are available for gynaecological cancer?
• Q32.33c What treatment options are available for ovarian cancer?

  Cancer of the Vulva, Vagina and Fallopian Tube

• 34 How prevalent are malignant conditions of the vulva, vagina and Fallopian tubes?

  Breast Cancer

• 35 What is the incidence of breast cancer?
• 35 ?What is the cause of breast cancer?
• 35a What are the advantages of breast cancer screening - mammography - mammograms?
• 36 How often should breast screening be carried out?
• 37 Are there any problems having a mammogram?
• 38 Should I check myself for breast lumps?
• 39 One of my family developed cancer of the breast. Am I at increased risk?
• 40 We have a family tendency towards developing breast / ovarian cancer. Are there any genetic tests to find out if I am at increased risk?
• 41 What happens if a mammogram shows an abnormality?
• 42 What are the advantages and disadvantages of tamoxifen in the management of breast cancer?
• 42a Breast Cancer Treatment - What is available?
• 43 What is the relationship between breast cancer and the pill?

  Web sites and Support Groups

• 44 Are there any support groups?
• 44 Are there any support groups?
• 45 Support Groups.
• 46 Breast Cancer Support Groups
• 47 Ovarian Cancer Support Groups
• 48 Endometrial Cancer Support Groups
• 49 Cervical Cancer Support Groups
  
  
  

  
  
  

  Thank you for choosing to visit us.

  
  

  This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

  I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.