Management of Endometrial Cancer: A Review

Abstract

Endometrial cancer is the most common malignancy of the female genital tract in developed countries and second to cervical cancer in India. Endometrial cancer predominately affects post menopausal women; however 15-25% of cases are diagnosed before menopause. Endometrial cancer is not amenable to screening, hence needs to be managed effectively as soon as diagnosis is made. Though quite a lot of studies have been conducted in this area, still there are controversies regarding few issues in its management. We decided to review the current literature on use of imaging techniques in diagnosing and assessing loco regional spread, mode of surgery, role of lymphadenectomy in early stage disease including sentinel lymph node status, adjuvant treatment and fertility preservation in women with endometrial cancer. Transvaginal ultrasound and MRI help in diagnosing the disease as well as locoregional spread of the tumor. Laparoscopy is replacing the conventional laparotomy without any increase in complication rate. Robotic technology being new has not been critically evaluated. Role of lymphadenectomy in early disease is still controversial. Only few studies have assessed the place of sentinel lymph node biopsy in the management of endometrial cancer. Fertility preservation in young women is the need of the hour and has been used with successful pregnancy outcome. There is need for more randomized controlled trials to clarify certain issues regarding management of endometrial cancer and on-going trials such as PORTEC3 and LACE may answer these queries.