treatment of Carcinoma Endometrium

1. Treatment of
Carcinoma
Endometrium
-Deepak Guru

2. Stage 0
Endometrial Hyperplasia

3. In younger women
• Progestogen therapy.
• Rx:
Medroxyprogesterone acetate (30-40 mg daily)
X 6-12 months.
OR
Norethisterone 10 mg daily.

4. In elderly women
- Total hysterectomy with removal of tubes and
ovaries.
-Transcervical resection- CONTRAINDICATED.

5. Stage I
- Cancer confined to Corpus Uteri.
- IA- Tumour limited to endometrium.
- IB- Half or less than half myometrial thickness
involved.
- IC- More than half myometrial thickness
involved.

6. Surgery
-
Staging
-
Abdominal Hysterectomy
-
Bilateral salpingo-oopherectomy
-
Omentectomy
-
Pelvic and para-aortic lymph node sampling.

7. Surgery
- Peritoneal washings: subdiaphragmatic area,
paracolic gutters and pelvis, for cytology.
- Open uterus and assess for tumor size,
myometrial invasion and cervical extension.
Frozen section preferred.

8. Stage IB and IC
- Post operative pelvic radiotherapy.
- 4000-5000 cGy over 5-6 weeks.
- Vaginal vault radiotherapy.

9. Stage II
- Tumour involves cervix but does not extend
beyond uterus.
- Brachytherapy followed 1 to 6 weeks later by
Surgery and External Radiotherapy.
- Alternately, Wertheim’s hysterectomy.

10. Stage III
- Local and/or regional spread
- IIIA- serosa, adnexa, peritoneal spread.
- IIIB- Vaginal metastasis.
- IIIC- Para-aortic/ Pelvic Lymph nodes.

11. Stage III
- INOPERABLE.
-
Doxorubicin 60 mg per sq. meter
Cisplatin and Paclitaxel.
Medroxyprogesterone acetate.
Whole abdomen irradiation 3000 cGy with
Kidney shielding.
- 1500 cGy and 2000 cGy para-aortic nodes and
pelvic irradiation.

12. Stage IV
-
Tumour widespread.
-
Palliative radiotherapy, chemotherapy and
progestrogen may prolong life.
-
Progestrogens:
MDPA 1g weekly or 200 mg OD.
or
Norethisterone 1g IM weekly.
- Tamoxifen 10 mg BD reduces oestrogen receptors.

13. Recurrent growth
- Vaginal vault, Lateral pelvic wall, lymph
nodes, lungs, liver, brain, bones.
- Tamoxifen 20-40 mg daily.

14. 5-year survival rate
Stage
Overall survival rate (%)
I
>90
II
65-80
III
35-45
IV
5-20

15. Thank You!
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