CHAPTER 34 - CANCER OF THE BODY OF THE UTERUS 437

lymphadenecto my o r postoperative radiotherapy. With

Table 34.2 Carcinoma of the Endometrium Staging increased experience in lapa roscopic surgery, most cases
(AGO 2009)
of endometrial cance r ca n be managed by this technique.
A robotic e ndoscopic surge!) is gaining popularity as a
Stage 1• Tumour confined to the corpus uteri
me tJ1od of surgical treatment.
lA· No or less than half myometrial invasion

18• Invasion equal to or more than half of the POSTOPERATIVE RADIOTHERAPY

myometrium
Applicatio n of postoperative •-adiothe•-ap)' depends on tJ1e
Stage II' Tumour invades cervical stoma, but does not surgicopa thological findings a nd staging.
extend beyond the uterus" The commonest local metaStaSis occurs in the vaginal
Stage 111• Local and/or regional spread of the tumour vault in 15% of cases. The incidence now has been reduced
to I %-2% by delh·e.-i ng radiation to the vaginal vault with
IliA• Tumour Invades the serosa of the corpus
the help of tJ1e colpostat 4 weeks after th e surge•) ' (brachy-
uteri and/or adnexae•
therap)•). A dose of 6000-7000 cGy is delivered over a
1118• Vaginal and/or parametrial Involvement• period of 6 weeks. Vaginal stenosis and dyspareunia are tll e
Ill CO Metastases to pelvic and/or para-aortic complications.
lymph nodes" Pel vic postoperative radiothe rapy (ex te rnal) in a dose of
6000 cGy over a 6-wee k pe riod is also reco mmended in
IIIC1• Positive pelvic nodes high-lisk cases such as undiffe rentiated tumou •~ myo metlial
--------------------
Positive para- aortic lymph nodes with or infiltrati on, pe lvic node involve me nt and in sero us, clear
IIIC2"
without positive pelvic lymph nodes cell and adenosq uamo us ca rcinoma. The postOperative
radio tJ1erap)' is required in Stages lA (Grade 3), LA2, lB
Stage Ill" Tumour Invades b ladder and/or bowel mucosa,
and/or distant metastases
and ll. For stage Ill and IV, chemo radiation therapy yie lds a
better effecL
r.tA• Tumour Invasion of bladder and/or bowel Whole-abdomen radiation is requi red when para-aortic
mucosa lymph nodes are invo lved, wh ile protecting the liver and
r.t8• Distant metastases, including intraabdominal kidneys.
metastases and/or inguinal lymph nodes lt is observed tJ1at women who receive pelvic radiother-
apy ofte n develop distal metastasis. There fore, so me advo-
•8ther G1 , G2 or G3
bErdocervical glandular irnolvement only should be consi:fered as
cate pelvic as well as abdominal radio111erapy to improve
Stage I and no boger as Stage II their survival.
•Postive cytology has to be reported sepa-ately \\ithout ch<Ylging The most importa nt factors in conside ring tJ1e need for
the stage. postsurgical radiotherapy a•·e as follows:
Source: RGO guidelnes.
( I ) Histology
(2) Grading as studied by biopsy
(3) Depth of myomeu·ial invasion as seen by ulu-asound,
2. Peritoneal washings are obtained from subdiaphrag- MRI and at the time of surger y
matic areas, pa1-acolic gutters and the pelvis, and sem for
cytology.
3. H ysterectomy and BSO,
PRIMARY RADIOTHERAPY
4. Omentectom y only if the hi stopathology report sugges- Stages lll and LV are not ope ra ble. They are u·eated with
tive of non enclo metrioid variety. brachytherapy followed by exte rnal rad iation. T he uterine
cavity can be packed with lleyman capsules. Adjuvant
After remova l, tJ1 e ute rus is cut opened tO loo k for tu· chemotherapy and progestoge n therapy prolong remission
mour s i:t.e, myome tri al in vasio n a nd ce rvical extension are and improve quality of life. llormona l th erapy is nontoxic
assessed. The froze n sectio n is preferred. Lymph node and does no t need hospitali:t.ati on.
sampli ng or lymp hadenectomy is indicated, if tumo ur is
more than 2 e m in si:t.e, it in vades more th an half the thick-
ness of endomeu·ium o r the exte nsion of th e disease is up
PROGESTOGEN$
to endocervix and if the preoperative grad ing of the tu- • Medroxyprogesterone ace ta te (MOPA) I g weekly or
mour was grade 2 o r 3. All grades 2 and 3 in Stage I, clear 200 mg o rally daily.
cell. serous a nd ade nosq uamo us cancers and myo metrial • 17-a progesterone or noretJ1 isterone I g i.m. weekly. Nor-
invasio n require pelvic l)lnphade necwmy and para-aortic e tllistero ne is su·onge r tJ1an MOPA and suppresses oestro-
lymph nod e sa mpling. The re is no need to remove the gen receptors. Thirt) per ce nt response witJ1 honno ne is
vagi nal cuff. However, omentectOmy is advisable in the repo11.ed. especiall) with lung metaStasis. Tamoxifen I 0 mg
adva nced stages. twice dail) is also useful in reducing oestrogen receptors
AltJ1 o ugh for surgeq an abdom ina l ro ute is convention- (for dlemothemp), refer to chapter 39).
a lly used, a vaginal route ca n be prefen·ed in o be se dia-
betic women a nd women with prolapse because it resultS Doxorubicin, platinum and taxa ne/ ca rboplas tin a re
in lesser mo•·biclity. This is combin ed with laparoscopic under trial.