A Advanced stage endometrial cancer diagnosis, 92 lymph node metastasis, 92 multivariate analysis, 92 myometrial invasion, 92 prognostic factors FIGO stage, 94 histological grade, 94, 95 histologic cell types, 94 intraperitoneal spread, 95 isthmus-cervix extension, 95 lymphovascular invasion, 95 myometrial invasion, 95 pelvic and para-aortic nodal metastasis, 96 ploidy and steroid receptors, 96 serous carcinoma, 94 serum levels, 92 stage III disease adjuvant chemotherapy, 99 hormonal therapy, 99 para-aortic radiation therapy, 98 risk factors, 97 surgery, 97 98 systematic therapy, 98 stage IV disease chemotherapy, 99, 100 combination chemohormonal therapy, 103 cytoreductive surgery, 99 hormonal therapy, 102 103 radiation therapy, 98, 101 tamoxifen and aromatase inhibitors, 103 surgical staging systems, 93 94 tumor-node-metastasis, 92, 93 Aromatase inhibitors, 113 B Bilateral salpingo-oophorectomy (BSO), 69 C Chemotherapy advanced stage endometrial cancer, 97 102 combined radiotherapy, 85 cytotoxic (see Cytotoxic chemotherapy) locoregional recurrence, 86 medical oncology, 124 125 metastatic and relapsed disease, 86 MIS, 85 non-resectable disease, 7 palliative, 125 platinum-based, 84 85, 87 Ciliated cell carcinoma, 34 Clear cell carcinoma, 35 36 Combination chemohormonal therapy, 103 Corpus cancer syndrome, 13 Cytoreductive surgery, 99 Cytotoxic chemotherapy carboplatin plus paclitaxel, 115 116 cisplatin plus doxorubicin, 113, 115 cisplatin plus paclitaxel, 113, 115 metastatic disease and relapse, 86 platinum-based combination, 113 E Early-stage endometrial cancer extrafascial hysterectomy, 56 histology assessment, 56 laparoscopic surgery, 58 lymphadenectomy, 58 63 omentectomy, 57 ovarian preservation, 57 Springer Nature Singapore Pte Ltd. 2017 R. Patni (ed.), Current Concepts in Endometrial Cancer, DOI 10.1007/978-981-10-3108-3 127
128 Early-stage endometrial cancer (cont.) pelvic and para-aortic lymphadenectomy, 56 peritoneal wash cytology, 56 radical hysterectomy, 57 randomized trials, 58 stage I disease extrauterine spread and relapse, 60 FIGO, 37 high risk, 68 intermediate risk, 68 low risk, 68 platinum-based chemotherapy, 84 85 robotic hysterectomy, 81 RT, 124 surgical management, 56 57 surgical treatment, 69 stage II disease radical hysterectomy, 57 robotic hysterectomy, 81 surgical treatment, 70 surgical staging, 57 58 tumour stage, 56 uterus-confined disease, 56 vaginal hysterectomy, 58 Endocrine therapy disease progression, 110 megestrol acetate, 110 metastatic disease and relapse, 86 Endometrial cancer clinical examination, 42 44 combination chemotherapy, 7 definition, 31 diagnosis chronic anovulation, 43 Color Doppler, 46 dilatation and curettage, 47 family history of malignancies, 44 guided biopsy, 46 47 hysteroscopy, 46 47 office endometrial biopsy, 44, 45 Pap smear, 44 postmenopausal bleeding, 42 43 sonohysterography, 46 tamoxifen-induced cystic hyperplasia, 43 transvaginal ultrasound examination, 45 46 FIGO grading, 32, 37 genetics of, 38 histological types, 31, 32 history, 42 44 imaging studies, 5 immunohistochemistry of, 36 37 incidence of, 42 locoregional recurrence, 7 MIS (see Minimally invasive surgery (MIS)) molecular categories, 8 pathophysiology macroscopy, 31 myometrial invasion, 31 obesity, 31 type I, 31 type II, 31 pelvic lymph node dissection, 6 pre-and postoperative radiotherapy, 5 pre-management workup, patients CECT, 49 51 cervical stromal involvement, 49, 50 Doppler, 49 fertility-preserving therapy, 51 imaging accuracy, 48 50 initial evaluation, 47, 48 magnetic resonance imaging, 49, 50 positron emission tomography, 51 superficial myometrial invasion, 49, 50 TVUS, 49 progestational therapy, 7 prognostic factors of, 37 retroperitoneal lymph nodes, 6 stages, 5, 48 symptoms, 42 tumor biology, 7 Endometrial intraepithelial neoplasia (EIN) schema, 22 benign, 20, 21 definitions, 20, 21 diagnostic criteria, 20, 21 hormonal treatment, 24 levonorgestrel-releasing intrauterine system, 24 malignant, 20 management of, 23 nonsurgical management, 23 24 pathologic criteria, 20 premalignant, 20 progestin regimes, 24 Endometrioid adenocarcinoma ciliated cells, 34 clear cell carcinoma, 35 36 epidemiologic characteristics, 32 grade 1, 32, 33 grade 3, 32, 34 morphologic patterns, 32 mucinous carcinoma, 35
proliferative phase endometrium, 32 SCC, 36 secretory phase endometrium, 34 serous carcinoma, 35 small cell carcinoma, 36 with squamous differentiation, 33 34 transitional cell carcinoma, 36 tumour necrosis and grading, 32 undifferentiated carcinoma, 36 villoglandular carcinoma, 34 Epidemiology, endometrial cancer clinical staging, 17 controlled diet, 17 diabetic postmenopausal women, 17 early detection, 17 endometrial biopsies, 17 protective factors breastfeeding, 16 cigarette smoking, 16 coffee drinking, 16 diabetes mellitus, 16 hormonal IUDs, 16 hormone replacement therapy, concomitant progesterone, 16 intrauterine devices, 16 metformin, 16 oral contraceptive pills, 15, 16 physical exercises, 15, 16 weight loss, 15, 16 women on tamoxifen, 17 risk factors age dependent, 12, 13 assessment, 17 diabetes mellitus, 12, 13 diet, 12, 13 family history, 12 HNPCC, 12, 14 hyperoestrogenic states, 12, 14 hypertension, 12, 13 infertility, 12, 14 menstrual history, 12, 14 microsatellite instability, 15 molecular alterations, 12 obesity, 12, 13 oestrogen-producing tumours, 12, 14 parity, 12 14 polycystic ovary syndrome, 12, 14 race, 12, 13 tamoxifen usage, pelvic hygiene, 12, 15 Estrogen replacement therapy (ERT), 14, 30 F Fertility-preserving therapy, 51 G Genetics, endometrial carcinoma, 38 H Hereditary nonpolyposis colorectal cancer (HNPCC), 14, 44, 68 Hormonal therapy, 7, 23, 86, 102 103 aromatase inhibitors, 113 parenteral and oral drugs, 112 progestational agents, 112 tamoxifen, 112 Hyperplasia, endometrium EIN diagnostic schema, 20 24 premalignant lesions, 29 30 WHO schema complex hyperplasia, 20 complex hyperplasia with atypia, 20 glandular complexity, 20 nuclear atypia, 20 poor reproducibility, 20 simple hyperplasia, 20 simple hyperplasia with atypia, 20 129 I International Federation of Gynecology and Obstetrics (FIGO) grading, 32, 37, 94 Intracavitary brachytherapy, 84 L Laparoscopic surgery cost-effectiveness, 58 vs. open surgery, 57, 123 vs. robotic surgery, 79, 80, 123 safety benefit, 58 Lymphadenectomy adjuvant therapy, 70 BSO, 69 distal boundary, 75 incidence, 59 indications, 60 inferior boundary, 76 intraoperative assessment, 59 lateral and proximal boundary, 75 limited survival benefit, 61 lymph node dissection, 61 pararectal and paravesical spaces, 76 pathological tumour grade, 59 patient s prognosis, 69 pelvic/para-aortic lymph node sampling, 25, 37, 56, 59 61, 76, 77, 87, 92, 96, 120, 123
130 Lymphadenectomy (cont.) randomized controlled trials, 61 robotic-assisted hysterectomy, 79, 81 role of, 123 sentinel node mapping, 62 63 surgical staging, 70 surgico-pathologically staged cancer, 58 59 survival benefit, 61 62 tumour stage, 59 Lynch syndrome, 4, 12, 14, 44, 68 M Management, endometrial cancer description, 119 imaging in, 120 medical oncology, 124 125 PubMed search, 120 radiation oncology adjuvant radiation, 124 radical radiation, 124 surgical oncology, 121 123 Medical oncology adjuvant chemotherapy, 124 125 hormonal therapy, 125 palliative chemotherapy, 125 Minimally invasive surgery (MIS) adjuvant treatment advanced disease, 86 chemotherapy and radiotherapy, 85 locoregional recurrence, 86 metastatic and relapsed disease, 86 87 platinum-based chemotherapy, 84 85 radiotherapy, 84, 85 risk stratification, 84, 85 vaginal recurrence, 86 anterior and posterior colpotomies, 76 bilateral pelvic lymphadenectomy, 76, 77 clinical use, 83 84 clinicopathological types, 68 efficacy of laparoscopy, 77 78 external radiation therapy, 83 84 follow-up and long-term implications, 88 histological subtype, 68 lymph node metastases, 68 lymphovascular space invasion, 68 maximal surgical debulking, 83 medical comorbidity, 6 myometrial invasion, 68 ovarian pedicles, 76 para-aortic lymphadenectomy, 76, 77 pathological features, 6 preoperative preparation technique medications, 71 patient positioning, 73, 74 port placement, 71 73 proctoclysis enema, 71 robotic instruments, 73, 74 zero-degree scope, 73 prognosis, 87 88 robotic surgical systems, 70 71, 78 83 stage I high risk, 68 intermediate risk, 68 low risk, 68 surgical treatment complication rate, 69 laparoscopy, 69 laparotomy, 68 for stage I, 69 for stage II, 70 tumor diameter, 68 uterine manipulator, 75 vesicouterine groove, 75 Mucinous carcinoma, 35 O Oestrogen-producing tumours, 12, 14 Office endometrial biopsy, 4, 44, 45, 47 P Palliative hormonal therapy, 125 Platinum-based chemotherapy, 84 85, 87 Polycystic ovary syndrome, 12, 14 Postmenopausal bleeding, 17, 22 23, 42 44 Precancer diagnosis dilatation and curettage, 22 endometrial sampling and imaging, 21 23 postmenopausal bleeding, 22 tumor markers, 23 Premalignant lesions assessment and management, 25 endometrial precancer classification, 20 hyperplasia classification systems (see Hyperplasia, endometrium) intraoperative assessment, 25 morcellation and endometrial ablation, 25 pathophysiology, 30 precancer diagnosis, 21 23 supracervical hysterectomy, 25
surgical staging, 25 type 1 and 2 tumors, 20 vaginal hysterectomy, 25 Progestational therapy, 7, 112 R Radiation therapy (RT) advanced stage endometrial cancer stage III disease, 100 stage IV disease, 99, 103 chemotherapy, 85 MIS, 83 84 tumor-directed, 97, 98 vaginal vault recurrences, 111 Recurrent endometrial cancer bevacizumab, 117 cytotoxic chemotherapy anterior exenteration, 113, 114 carboplatin plus paclitaxel, 115 116 cisplatin plus doxorubicin, 113, 115 cisplatin plus paclitaxel, 113, 115 platinum-based combination, 113 diagnosis, 110 hormonal therapy aromatase inhibitors, 113 parenteral and oral drugs, 112 progestational agents, 112 tamoxifen, 112 isolated vaginal vault recurrences, 111 112 second-line therapy, 116 117 surgery role, 112 temsirolimus, 117 women, treatment, 110 Robotic-assisted surgery applications, 70 binocular stereoscopic 3D vision, 70 efficacy of, 81 82 vs. laparoscopic surgery, 123 learning curve, 79 80 limitations of, 82 83 motion scaling and precision, 71 obesity, 78 79 survival analysis, 80 S Secretory carcinoma, 34 Sentinel node mapping for uterine cancer, 62 63 Serous carcinoma, 8, 15, 35, 37, 38, 87, 94, 102 Small cell carcinoma, 36 Squamous cell carcinoma (SCC), 36 131 Surgical oncology early-stage/uterus-confined disease (see Early-stage endometrial cancer) fertility-preserving surgery, 121 lymphadenectomy, 123 lymph nodal disease nomograms, 121 122 sentinel lymph node procedure, 122 123 technique of laparoscopic vs. open surgery, 123 robotic vs. laparoscopic surgery, 123 Surveillance, epidemiology and end results (SEER) database abnormal uterine bleeding, 4 anti-aromatase agents, 3 aromatase inhibitor therapy, 3 hysteroscopy-guided biopsy, 4 immunohistochemical analysis, 3 lymphadenectomy, 62 precursor lesions, 3 reproductive trends, 2 survival trend, 2 timely assessment, 4 Women s Health Initiative, 3 T Tamoxifen, 112 induced cystic hyperplasia, 43 The Cancer Genome Atlas (TCGA), 8 Transitional cell carcinoma, 36 U Undifferentiated carcinoma, 36 Uterine sarcoma, 8, 43 V Vaginal brachytherapy (VBT), 7, 124 Vaginal-cervical Ahluwalia retractor-elevator (VCARE) uterine manipulator, 73 Vaginal vault recurrences, isolated pelvic exenteration, 111 radiation therapy, 111 tailored treatment approaches, 111 112 Villoglandular carcinoma, 34 W WHO schema classification, 20, 29