Endometrial carcinoma: is there a place for radical surgery?

Endometrial carcinoma may require a combination of therapeutic modalities to effect a cure. The generalist obstetrician and gynaecologist wishing to treat endometrial carcinoma must be fully conversant with current developments in gynaecological cancer therapy. Referral of patients to centres with special expertise in gynaecological oncology is desirable for accurate clinical evaluation and the selection of optimal treatment. There is a limited place for radical surgery in the treatment of endometrial carcinoma. Evaluation of nodal status is essential to surgical staging and allows for individualization of postoperative therapy. Radical hysterectomy and pelvic lymphadenectomy is reasonable treatment for Stage II disease if the patient is fit and irradiation is contraindicated. There has been little improvement in survival despite the use of radical surgery and improved delivery of radiation. New strategies are needed to combat this disease. We can now identify women with significant risk of metastases and treatment failure. These women need effective adjuvant therapy to achieve improved cure of their cancer. Hormonal manipulations are under investigation and immunotherapy may eventually have a therapeutic role, but is currently experimental. Chemotherapy has a proven effect in some disseminated malignancies. It would seem that we are ready for the development and evaluation of perioperative chemotherapeutic regimens.