treatment of Ca Endometrium

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treatment of Carcinoma Endometrium

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treatment of Ca Endometrium

  1. 1. Treatment of Carcinoma Endometrium -Deepak Guru
  2. 2. Stage 0 Endometrial Hyperplasia
  3. 3. In younger women • Progestogen therapy. • Rx: Medroxyprogesterone acetate (30-40 mg daily) X 6-12 months. OR Norethisterone 10 mg daily.
  4. 4. In elderly women - Total hysterectomy with removal of tubes and ovaries. -Transcervical resection- CONTRAINDICATED.
  5. 5. Stage I - Cancer confined to Corpus Uteri. - IA- Tumour limited to endometrium. - IB- Half or less than half myometrial thickness involved. - IC- More than half myometrial thickness involved.
  6. 6. Surgery - Staging - Abdominal Hysterectomy - Bilateral salpingo-oopherectomy - Omentectomy - Pelvic and para-aortic lymph node sampling.
  7. 7. Surgery - Peritoneal washings: subdiaphragmatic area, paracolic gutters and pelvis, for cytology. - Open uterus and assess for tumor size, myometrial invasion and cervical extension. Frozen section preferred.
  8. 8. Stage IB and IC - Post operative pelvic radiotherapy. - 4000-5000 cGy over 5-6 weeks. - Vaginal vault radiotherapy.
  9. 9. Stage II - Tumour involves cervix but does not extend beyond uterus. - Brachytherapy followed 1 to 6 weeks later by Surgery and External Radiotherapy. - Alternately, Wertheim’s hysterectomy.
  10. 10. Stage III - Local and/or regional spread - IIIA- serosa, adnexa, peritoneal spread. - IIIB- Vaginal metastasis. - IIIC- Para-aortic/ Pelvic Lymph nodes.
  11. 11. Stage III - INOPERABLE. - Doxorubicin 60 mg per sq. meter Cisplatin and Paclitaxel. Medroxyprogesterone acetate. Whole abdomen irradiation 3000 cGy with Kidney shielding. - 1500 cGy and 2000 cGy para-aortic nodes and pelvic irradiation.
  12. 12. Stage IV - Tumour widespread. - Palliative radiotherapy, chemotherapy and progestrogen may prolong life. - Progestrogens: MDPA 1g weekly or 200 mg OD. or Norethisterone 1g IM weekly. - Tamoxifen 10 mg BD reduces oestrogen receptors.
  13. 13. Recurrent growth - Vaginal vault, Lateral pelvic wall, lymph nodes, lungs, liver, brain, bones. - Tamoxifen 20-40 mg daily.
  14. 14. 5-year survival rate Stage Overall survival rate (%) I >90 II 65-80 III 35-45 IV 5-20
  15. 15. Thank You! <<<Treatment of Carcinoma Endometrium>>>

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