There are many types of endometrial cancer, and each type is treated differently.

Author: Pan Zhiyin, deputy chief physician of Foshan First People's Hospital

Reviewer: Wang Gang, Chief Physician, Sichuan Provincial Maternal and Child Health Hospital

As one of the three major gynecological malignant tumors, the incidence of endometrial cancer has increased year by year (second only to ovarian cancer and cervical cancer), and the age of onset is getting younger, which has seriously affected the life and health of women.

Next, let us learn more about endometrial cancer.

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1. Classification of endometrial cancer

First, let us understand the classification of endometrial cancer.

According to the pathogenesis and biological characteristics, endometrial cancer can be divided into type I (estrogen-dependent) and type II (non-estrogen-dependent), also known as endometrial adenocarcinoma and non-endometrial adenocarcinoma. Endometrial adenocarcinoma accounts for about 90% of endometrial cancer and has a good prognosis. Non-endometrial adenocarcinoma, also known as special subtypes of endometrial cancer, mainly includes serous carcinoma, clear cell carcinoma, mucinous carcinoma, etc., accounting for about 10% of all endometrial cancers, and has a poor prognosis.

Treatment of different types of endometrial cancer

Treatment varies depending on the type of endometrial cancer.

Regardless of the type of endometrial cancer, the basic principle of "comprehensive treatment with surgery as the main approach" must be followed. On the premise of following standardization, it is also necessary to formulate an appropriate treatment plan based on the tumor's histological type, cumulative range, and whether there are high-risk factors that affect prognosis, taking into account the patient's age, culture, economics, and general condition.

Different types of endometrial cancer have different treatment plans. For patients with early-stage endometrial cancer whose tumors are confined to the uterus, comprehensive staged surgery is recommended; for patients whose tumors have spread beyond the uterus, surgery is used to remove the lesions and reduce the tumor burden, followed by radiotherapy and chemotherapy. For patients with advanced endometrial cancer who have lost the opportunity for surgery, palliative treatments such as chemotherapy and endocrine therapy can be tried.

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The basic surgical procedure for type I endometrial cancer is hysterectomy and bilateral salpingo-oophorectomy, with the possibility of no retroperitoneal lymph node dissection or only pelvic lymph node dissection. However, when patients have high-risk factors that affect prognosis, such as poor differentiation, deep myometrial invasion, vascular space invasion, tumor diameter greater than 2 cm, cervical metastasis, and preoperative imaging examinations or intraoperative exploration indicating lymph node metastasis and extrauterine metastasis, retroperitoneal lymph node dissection up to the level of the renal vessels is required.

Type II endometrial cancer requires comprehensive staging surgery, which requires not only routine retroperitoneal lymph node dissection up to the level of the renal vessels but also resection of the greater omentum.

In general, type I endometrial cancer is mainly treated with surgery, and generally has a good prognosis, while type II endometrial cancer often requires chemotherapy after surgical treatment, and generally has a poor prognosis.

Factors affecting the prognosis of endometrial cancer

In clinical work, what factors affect the prognosis of endometrial cancer?

The prognosis of endometrial cancer is related to the patient's age, type, stage, tissue grade, lymph node metastasis, etc.

Age is an important factor affecting the prognosis of endometrial cancer, and the older the patient, the worse the prognosis. Lymph node metastasis is the main metastatic pathway of endometrial cancer. If the patient has lymph node metastasis, the prognosis is poor.

The type of endometrial cancer, family history of tumors, and extrauterine invasion are independent risk factors that affect prognosis. Among the types of endometrial cancer, the risk of death in non-endometrial adenocarcinoma is more than 8 times that of endometrial adenocarcinoma. Family history of tumors is a risk factor for many tumors. The risk of death in patients with a family history of endometrial cancer is about 7 times that of patients without a family history of endometrial cancer.

The prognosis of endometrial cancer plays an important role in the patient's choice of treatment method, and the prognosis of endometrial cancer is affected by many factors. Therefore, doctors will carefully analyze the patient's prognosis when formulating a treatment plan for endometrial cancer patients.

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Conclusion

Before treatment, patients should fully understand the pros and cons of various therapies in order to decide on follow-up treatment, and actively learn about cancer prevention and treatment, have regular physical examinations, quit smoking and drinking, control their weight, and develop healthy living habits.

References

[1] Chen Yanli, Yu Da, Zhang Qian, et al. Relationship between tumor size and prognosis of endometrial cancer[J]. Chinese Practical Medicine. 2021, 16(35): 68-71.

[2] Zheng Li'e, Wu Yalan, Xie Qing, et al. Analysis of influencing factors after endometrial cancer surgery and construction of prognostic index model[J]. Journal of Fujian Medical University. 2021, 55(5): 477-450.