Endometrial carcinoma : Risk Factors • Obesity; often associated with diabetes mellitus, arterial hypertension • Early menarche, late menopause, nulliparity • Polycystic ovarian syndrome (PCOS) • Atypical adenomatous endometrial hyperplasia • Estrogen-producing tumors • Estrogen therapy (“unopposed,” i.e., without progesterone) • Tamoxifen therapy, pelvic radiotherapy Genetic Factors • Familial predisposition: HNPCC (hereditary non-polyposis colorectal cancer; Lynch II syndrome): high risk of extraintestinal tumors, e.g., endometrial carcinomas, in 43% of affected women • Other aberrations: K-ras and PTEN mutations, rarely p53 mutations Surgical Treatment According to Disease Stage • Stage I: abdominal hysterectomy, bilateral adnexectomy, lymphadenectomy (pelvic, para-aortic) according to risk factors • Stage II: extended radical hysterectomy (Wertheim), bilateral adnexectomy, lymphadenectomy (pelvic and para-aortic) • Stage III: hysterectomy, bilateral adnexectomy, lymphadenectomy (pelvic, para-aortic), omentectomy, colpectomy (partial or complete) • Stage IVA: anterior and/or posterior exenteration, alternatively (with contraindications to surgery) percutaneous irradiation of the true pelvis • Stage IVB: multimodal therapy, combination of hysterectomy, surgical tumor reduction and radiotherapy as well as chemotherapy
Posted on: Mon, 28 Oct 2013 12:52:48 +0000
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