[Therapy of endometrial cancer]

Surgical-pathological categorising of endometrial carcinoma makes it possible to treat this cancer in a more differentiated way. In clinical stage I, 6% of the adnexes, 10% of the pelvic lymph nodes and 5% of the paraaortic lymph nodes are affected. There is a direct correlation between depth of invasion and pelvic and paraaortic lymph node metastases. The new surgical-pathological categorising of endometrial carcinoma requires extensive surgery. Lymphadenectomy, which is necessary for categorisation means over-treatment for 2 thirds of all cases. Today, low-risk endometrial cancers can be distinguished from high risk ones by vaginal sonography as well as NMR permits the detection of invasion preoperatively and curettage to determine the unfavorable subtypes (seropapillary, clear-cell), hormonal receptors and ploidy. In low-risk cases, hysterectomy (with adnexes) and careful revision of the abdomen is sufficient. No further adjuvant therapy is necessary. In high-risk cases, an extended pelvic and, in the case of metastases, an para-aortic lymphadenectomy is imperative. Percutaneous X-ray therapy is not necessary in low-risk cases postoperatively. In high-risk cases, its effectiveness is not established and is probably not superior to the operative removal of metastases. Radiation of the vaginal cuff is necessary and successful in high-risk cases. In low-risk cases, side-effects are minimal. Adjuvant therapy with gestagens in low-risk cases is not indicated, because of their side-effects and does not reduce recurrence rate. Recurrent and metastasizing endometrial carcinomas respond to gestagens in about 15% of cases. Response is receptor dependent. High dose is not more effective. Endometrial carcinoma responds to chemotherapy. Most effective is adriamycin with a response rate of 35%. Combination therapies did not show greater effect in randomized studies. Recurrence free interval is only 6 to 8 months, however. An adjuvant chemotherapy is only indicated in the case of a serous carcinoma.