Abstract
Although endometrial carcinoma (EC) is generally considered to have a good prognosis, over 20% of women with EC die of their disease, with a projected increase in both incidence and mortality over the next few decades. The aim of accurate prognostication is to ensure that patients receive optimal treatment and are neither overtreated nor undertreated, thereby improving patient outcomes overall. Patients with EC can be categorized into prognostic risk groups based on clinicopathologic findings. Other than tumor type and grade, groupings and recommended management algorithms may take into account age, body mass index, stage, and presence of lymphovascular space invasion. The molecular classification of EC that has emerged from the Cancer Genome Atlas (TCGA) study provides additional, potentially superior, prognostic information to traditional histologic typing and grading. This classifier does not, however, replace clinicopathologic risk assessment based on parameters other than histotype and grade. It is envisaged that molecular and clinicopathologic prognostic grouping systems will work better together than either alone. Thus, while tumor typing and grading may be superseded by a classification based on underlying genomic abnormalities, accurate assessment of other pathologic parameters will continue to be key to patient management. These include those factors related to staging, such as depth of myometrial invasion, cervical, vaginal, serosal surface, adnexal and parametrial invasion, and those independent of stage such as lymphovascular space invasion. Other prognostic parameters will also be discussed. These recommendations were developed from the International Society of Gynecological Pathologists Endometrial Carcinoma project.
Highlights
Not suitable for primary surgeryCervical biopsy or pelvic MRI (if not previously done): positive result; medically operable
Adjuvant EBRT Adjuvant chemotherapy can be considered Adjuvant vaginal brachytherapy for G1-2 lymphovascular space invasion (LVSI) negative Adjuvant limited field EBRT for G3 or LVSI unequivocally positive; consider brachytherapy boost Adjuvant EBRT, consider brachytherapy boost Adjuvant chemotherapy for G3 or LVSI unequivocally positive should be considered Chemotherapy plus EBRT to be considered for IIIA, IIIB and IIIC1 Chemotherapy plus enhanced field EBRT to be considered for IIIC2 Serous and clear cell after comprehensive staging: Chemotherapy Stage IA, LVSI negative: Vaginal brachytherapy Stage ≥ IB: EBRT plus chemotherapy especially if node positive Carcinosarcoma and undifferentiated tumors: Chemotherapy Consider EBRT
If myometrial invasion occurs from carcinoma within adenomyosis, the deepest myoinvasive point should be reported according to where this is located in the myometrium, and regardless of whether or not it arises from adenomyosis
Summary
Cervical biopsy or pelvic MRI (if not previously done): positive result; medically operable. Cervical biopsy or pelvic MRI (if not previously done): positive result; not suitable for primary surgery. CA125 (optional); imaging as clinically indicated (if not previously done): no evidence of extrauterine disease. CA125 (optional); imaging as clinically indicated (if not previously done): ascites; omental/peritoneal involvement; nodal (including inguinal) involvement; ovarian involvement. Unresectable extrauterine pelvic disease: vaginal; bladder; bowel/rectum; parametrial; nodal
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