Endometrial Cancer. Saudi Gynecology Oncology Group (SGOG) Gynecological Cancer Treatment Guidelines

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Clinton Reynolds
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1 Saudi Gynecology Oncology Group (SGOG) Gynecological Cancer Treatment Guidelines Endometrial Cancer Emad R. Sagr, MBBS, FRCSC Consultant Gynecology Oncology Security forces Hospital, Riyadh

2 Epidemiology The most common gynecological malignancy 3.4 % of all cancers in 2006 (n=140) Ranking # 6

3 Cellular Classification Endometrioid (75% 80%) Papillary serous (<10%) Mucinous (1%) Clear cell (4%) Squamous cell (<1%) Mixed (10%) Undifferentiated.

4 PRETREATMENT EVALUATION Complete pelvic and general physical examination Pathology review CA 125 Radiographic studies

5 Surgical staging Intraoperative gross inspection Peritoneal washing Total extrafascial hysterectomy with bilateral salpingo-oophorectomy Lymph node evaluation

6 Lymph nodes evaluation Clinical evaluation Nodes sampling Nodes resection (Lymphadenectomy) Pelvic only Pelvic and para-aortic Level of para-aotric Sentinel node biopsy Benedetti et al, J Natl Cancer Inst Dec 3;100(23): Epub 2008 Nov 25. Kitchener et al, Lancet Jan 10;373(9658): Epub 2008 Dec 16.

7 Staging

8 Stage 1 In the face of negative nodes there was little survival difference between no myometrial invasion and less than 50% invasion

9 Stage 2 Involvement of the endocervix that does not invade the stoma is not a Stage II lesion

10 Stage 3 IIIA: Involvement of the Serosa or Adnexa IIIB: Involvement of the vagina Parametrium Pelvic peritoneum IIIC: IIIC1 Pelvic nodes IIIC2 Paraaortic nodes

11 Stage 4

12 Risk stratification Low risk Intermediate risk High risk

13 Low and intermediate risk G1 G2 G3 1A 1B

14 POSTOPERATIVE ADJUVANT THERAPY

15 Adjuvant treatment for completely staged Observe G1 G2 G3 IA IB ± chemotherapy Adverse risk factors: Age, positive LVSI, tumor size, lower uterine (cervical/glandular) involvement

16 Adjuvant treatment for completely staged Observe G1 G2 G3 IA IB ± chemotherapy Creutzberg et al, PORTEC3, Hogberg et al, NSGO-EC-9501/EORTC 55991

17 Adjuvant treatment for completely staged G1 G2 G3 II Pelvic RT Pelvic RT + vaginal brachytherapy Pelvic RT + vaginal brachytherapy ± chemotherapy

18 Adjuvant treatment for completely staged IIIA Chemotherapy ± RT Tumor-directed RT ± chemotherapy Pelvic RT ± vaginal brachytherapy IIIB Chemotherapy and/or tumor-directed RT IIIC Chemotherapy and/or tumor-directed RT IVA Chemotherapy ± RT IVB Chemotherapy ± RT

19 Choice of chemotherapy Doxorubicin / Cisplatin Doxorubicin / Cisplatin / Paclitaxel Carboplatin / Paclitaxel

20 Incomplete surgical staging G1 G2 G3 IA IB II Radiologic imaging if myometrial invasion If positive à Restaging If negative à Brachytherapy Radiologic imaging If positive à Surgical restaging or pathologic confirmation of metastatic disease If negative à Pelvic RT + vaginal brachytherapy ± para-aortic RT ± chemotherapy for Grade 3 tumors

21 POSTTREATMENT FOLLOW-UP Physical examination every 3 months for two years, then every six months for 3 years, then annualy Vaginal cytology every six months for two years, then annually Optional measurement of serum CA-125 at each visit Annual chest x-ray CT/MRI only as clinically indicated

22 Discussion

Adjuvant Therapies in Endometrial Cancer. Emma Hudson

Adjuvant Therapies in Endometrial Cancer Emma Hudson Endometrial Cancer Most common gynaecological cancer Incidence increasing in Western world 1-2% cancer deaths 75% patients postmenopausal 97% epithelial