[Treatment of cancer of the endometrium]

Basically, endometrial carcinomas are treated by surgery. The standard operation consists of total hysterectomy with ablation of the adnexae and bilateral dissection of the external iliac lymph nodes. Invasion of the parametrium is extremely rare, and colpohysterectomy is justified only when the cervix is involved. Improvements in anaesthesia and intensive care have limited the contra-indications of surgery. As a rule, hysterectomy is combined with vaginal curietherapy which has reduced recurrences at the vaginal fornices from 12 p. 100 to 3 p. 100. Uterovaginal curietherapy is necessary only in cases where the endometrium and cervix are involved. Invasion of the myometrium in depth and a histological diagnosis of undifferentiated epithelioma are predictive of a poor prognosis and may justify a complementary treatment. Post-operative external radiotherapy of the pelvis is indicated when the lymph nodes and adnexae are involved and the deep myometrium is invaded. It reduces the local recurrence rate but its influence on survival has not yet been formally demonstrated. Local and regional recurrences are treated by radiotherapy if the initial treatment was surgical and by surgery if radiotherapy was part of the initial treatment. Chemotherapy and hormonotherapy are effective against advanced, recurrent or metastatic carcinomas. Chemotherapy is used in undifferentiated types and hormonotherapy in differentiated types. However, when used as adjuvants in early endometrial carcinoma their beneficial effect on survival has not been established.