Endometrial cancer
What is it?
Endometrial cancer is defined as a neoplasm arising from the uterine body at the level of endometrial cells. It is the most frequent gynecological neoplastic disease in Europe.
Endometrial cancers are divided into type 1 and type 2 tumors.
Type 1 (endometrioid) tumor is the most frequent, and usually estrogen-sensitive. Risk factors for this type of cancer include: early menarche, late menopause, ovarian polycystosis, nulliparity, obesity. This is a generally well-differentiated tumor with a better prognosis than type 2.
Type 2 tumors are generally high-grade, non-hormone-sensitive and include serous, clear cell and undifferentiated forms.
Which are the symptoms?
The clinical picture is usually characterized by the appearance of atypical blood loss, i.e. profuse vaginal bleeding (red flag, especially if in post-menopausal age) and pelvic pain, the latter occuring later on.
- menopausal bleeding
- irregular vaginal bleeding
- pelvic pain
How is it diagnosed?
The diagnosis of endometrial cancer is always suspected in cases of menopausal blood loss or bleeding of a hemorrhagic nature in pre-menopause. The suspicion can be deepened by performing gynecological ultrasound that shows pathological thickening of the endometrium. The diagnosis of certainty is based on the execution of an endometrial biopsy with histological examination. More in-depth investigations include molecular diagnostics and genetic investigations to search for specific mutations.
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How is it treated?
Early stages can be treated surgically, preferring the minimally invasive laparoscopic approach to the invasive laparotomy, where possible. The technique of sentinel lymph node detection by indocyanine green can be considered in cases of myometrial invasion and allows to avoid pelvic and lumbar-aortic lymphadenectomy necessary for the correct staging. When surgical radicality is possible, stage III and IV are treated surgically; in cases where surgery is not possible, there is indication for chemotherapeutic treatment.
Therapeutic strategies are discussed in the multidisciplinary consultation which may include surgery, radiotherapy and chemotherapy in different combinations based on the location and stage of the disease. Radiotherapy can be used as post-operative adjuvant treatment in combination with chemotherapy in patients with node-positive endometrial cancer or cervical cancer with adverse factors.
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Where do we treat it?
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