Endometrial Cancer - Evaluation of Diagnostics Treatment and Prognosis in 150 Patients

Abstract

OBJECTIVE: In this study we aim to discuss diagnostic and tratment modalities and prognostic factors of 150 patients that were admitted to our clinic between October 2002 and May 2009 in a retrospective way in regard with the current literature.
STUDY DESIGN: Patients’ all demographic data were recorded upon admittance, diagnostic and treatment options that were perfomed were also recorded and thus are used in this study.
RESULTS: Patients’ median age was 67.1±11 ,2 (52-79) , Trans vaginal ultrasonography (TVUSG) was used to measure endometrial thickness and the median was 15.7± 4.91 mm (6-36). All patients were diagnosed with fractional curretage before admittance to the gynecological oncology clinic, all underwent
total abdominal hysterectomy bilateral salpingoopherectomy and bilateral pelvic–para aortic lymphadenectomy (performed if FIGO critera are met). Surgical staging results were as follows; 78% Stage 1, 10% Stage 2, 8% Stage 3 and 4% were Stage 4. Histopathological differentiation resulted largely in favor of Endometrioid adenocarcinoma with 132 patients (88%), 6 cases of Serous papillary carcinoma
(4%), 7 cases of Clear cell carcinoma (4.6%), 3 cases of Mucinous carcinoma (2%) and 2 cases of Undifferentiated carcinoma (1.3%). In terms of grading, 28 patients (18.6%) were classified as high grade and among 132 patients that were classified as endometrioid carcinoma 69 were grade I (52.2%), 52 were grade II (39.3%) and 11 were grade III (8.3). In terms of myometrial invasion beyond 50%, grade I patients were less likely to, with only 5.2%, and 39% and 76.3% for grades II and III respectively. Lymph node dissection was performed on 71 patients among which 8 had positive pelvic lymph nodes (5.3%) and 2 had positive aortic lymph nodes (1.3%). All high grade patients had positive peritoneal cytology.
Lymphovascular space invasion was present in 36 of the patients (24%) of which 3 were grade I (8.3%), 12 were grade II (33.3%) and 11 were grade III (30.5%). Among 16 patients that had cervical invasion 14 also had lymphovascular space invasion (LVSI) (87.5%).
CONLCLUSION: Survival in endometrial carcinoma depends on many factors starting with the FIGO staging, histological type of the tumour, its histological grade, lymphovascular invasion, treatment modalities and patient specific variables such as age, BMI, parity.