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Stage I Endometrial Cancer

    Standard treatment options:

    A total hysterectomy and bilateral salpingo-oophorectomy should be done if the tumor:

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    General Information About Cervical Cancer

    Cervical cancer is a disease in which malignant (cancer) cells form in the cervix. The cervix is the lower, narrow end of the uterus (the hollow, pear-shaped organ where a fetus grows). The cervix connects the uterus to the vagina (birth canal). Anatomy of the female reproductive system. The organs in the female reproductive system include the uterus, ovaries, fallopian tubes, cervix, and vagina. The uterus has a muscular outer layer called the myometrium and an inner lining called...

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    • Is well or moderately differentiated.
    • Involves the upper 66% of the corpus.
    • Has negative peritoneal cytology.
    • Is without vascular space invasion.
    • Has less than a 50% myometrial invasion.

    Selected pelvic lymph nodes may be removed. If they are negative, no postoperative treatment is indicated. Postoperative treatment with a vaginal cylinder is advocated by some clinicians.[1]

    For all other cases and cell types, a pelvic and selective periaortic node sampling should be combined with the total hysterectomy and bilateral salpingo-oophorectomy, if there are no medical or technical contraindications. One study found that node dissection per se did not significantly add to the overall morbidity from hysterectomy.[2] While the radiation therapy will reduce the incidence of local and regional recurrence, improved survival has not been proven and toxic effects are worse.[3,4,5,6] Results of two randomized trials on the use of adjuvant radiation therapy in patients with stage I disease did not show improved survival but did show reduced locoregional recurrence (3%–4% vs. 12%–14% after 5–6 years' median follow-up, P < .001) with an increase in side effects.[6,7,8][Level of evidence: 1iiDii]

    If the pelvic nodes are positive and the periaortic nodes are negative, total pelvic radiation therapy, including the common iliac nodes, should be given. The incidence of bowel complications is approximately 4%, and it can be even higher if the radiation therapy is given after pelvic lymphadenectomy.[9] If the surgery is done using a retroperitoneal approach, the toxic effects are lessened. If the periaortic nodes are positive, the patient is a candidate for clinical trials that could include radiation therapy and/or chemotherapy. Patients who have medical contraindications to surgery should be treated with radiation therapy alone, but inferior cure rates below those attained with surgery may occur.[1,10,11]

    Several randomized trials have compared total laparoscopic hysterectomy (TLH) with the standard open procedure, total abdominal hysterectomy (TAH), for patients with early-stage endometrial cancer. Thus far, these reports have been limited to the feasibility of the procedure and quality of life. Feasibility of the laparoscopic approach has been confirmed, although TLH is associated with a longer operative time.[12,13,14] TLH had an improved [12,13] or similar [14] adverse event profile and a shorter hospital stay [12,13,14] when compared with TAH. TLH was associated with less pain and quicker resumption of daily activities,[14,15] although one study found that most of the gains in quality of life favoring laparoscopy at the 6-week postsurgical period were no longer significant at 6 months.[14,15] Questions remain regarding the efficacy of TLH compared with TAH for endometrial cancer [16] and are awaiting the reports of disease-free survival and overall survival (OS) from these phase III studies.


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