Treatment of Endometrial cancer generally consists of
laparoscopic or open staging procedure including pelvic washings, extrafascial total hysterectomy, bilateral salpingo-oophorectomy, and sometimes omentectomy. Pelvic and para-aortic lymphadenectomy is considered both diagnostic and therapeutic and should be performed in all patients. Intraoperative evaluation of the uterus should be performed by bivalving the uterus and obtaining a frozen section as needed. Adjuvant radiotherapy and/or chemotherapy is used postoperatively in patients with poor prognostic factors who are at high risk for recurrence. Hormonal therapy or chemotherapy is used for advanced disease, but response to chemotherapy has been poor.
TABLE 36-3 Endometrial Cancer Staging
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Prognosis of Endometrial cancer generally is favorable,
with 5-year survival greater than 90% for patients with surgical stage I tumors (Table 36-3). Prognosis depends on the grade of tumor as well as the depth of myometrial invasion, adnexal involvement, pelvic cytology, lymph vascular space invasion, and lymph node spread. Rarer histologies, such as clear-cell or papillary serous cancers and the sarcomas arising from the wall of the uterus, do not share the overall good prognosis of early-stage adenocarcinomas. African American women have mortality rates nearly twice that of white women.