A contemporary review of uterine cancer management

Abstract

Cancer of the uterine corpus is the most common of all the gynaecological cancers. Whilst most are sporadic, a small proportion may develop as a consequence of genetic predisposition, most commonly hereditary nonpolyposis colon cancer. The surgical management remains resection of the uterus with some short-term advantages for a minimally invasive approach. Surgical staging to define the extent of disease may be advocated but its ability to affect survival has not been demonstrated. If surgical staging is undertaken, the routine performance of a para-aortic lymph node dissection must be questioned. Adjuvant radiation therapy whilst reducing locoregional recurrence has not been shown to improve survival. Whilst the definitions of risk vary, grade 1 and 2 tumours, invading <50% into the myometrium, are considered low risk and should not be offered adjuvant therapy. Women with grade 3 tumours invading >50% into the myometrium have an increased risk of regional nodal spread and distant spread and recurrence. In these high-risk cases, pelvic radiation therapy will reduce local and regional recurrence but will not impact upon survival. The addition of systemic therapy in this group is an attractive proposition with limited supportive evidence. All other patients are of intermediate risk of recurrence, and the addition of vaginal vault brachytherapy will reduce vaginal vault recurrences. Whilst there is no evidence to support a role for adjuvant hormonal therapy in apparent early-stage disease, progestin therapy does have a role in nonlocalised advanced or recurrent disease.