並列摘要
Endometrial carcinoma is a low grade curable malignancy and most patients present with early disease with excellent survival. Of all female pelvic malignancies, it seems to have more advocates for different treatment plans than any other. The incidence rises with age and is significantly increased when there is exposure to unopposed estrogen. The long term use of tamoxifen for breast cancer is also associated with an increased incidence of endometrial cancer. Transvaginal ultrasound and pipelle or hysteroscopy endometrial biopsies are tending to replace the traditional dilation and curettage in establishing a diagnosis. 90% of endometrial tumors are surgically resectable on presentation. This remains the first line management-minimally, a total extrafascial hysterectomy and bi-lateral salpingo oophorectomy. Prognostic factors include the histological grade, the depth of invasion of the myometrium, the presence or absence of lymph-vascular space invasion and involved regional nodes, tumor volume, and the presence or absence of involvement of the cervix. The pelvis is a major anatomical site at risk of recurrence, and since cytotoxic chemotherapy and hormone therapies have limited effectiveness, radiotherapy is the adjuvant therapy of choice where adverse prognostic factors are present. Pelvic lymhadenectomy is performed in most centers on therapeutic and prognostic grounds and to individualize adjuvant treatment. Treatment planning is conservative in order to reduce patients morbidity and overtreatment while maintaining acceptable recurrence and survival rates. Patients who are not medically fit for surgery or who have inoperable disease are managed with radical radiotherapy but the results in both these groups are inferior to those obtained with radical surgery. Spread outside the pelvis to para-aortic nodes may still be salvaged with local irradiation, but systemic disease is incurable and treatment is largely palliative including consideration of local irradiation, hormone therapy or chemotherapy for symptomatic relief.
並列關鍵字
Endometrial cancer延伸閱讀
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