Hematology/Oncology Clinical Practice Guidelines: 2018 Midyear Review

John Anello; Brian Feinberg; John Heinegg; Yonah Korngold; Richard Lindsey; Cristina Wojdylo; Olivia Wong, DO

Disclosures

July 09, 2018

In This Article

Endometrial Cancer Surgical Staging

National Comprehensive Cancer Network

Total hysterectomy/bilateral salpingo-oophorectomy (TH/BSO) and lymph node assessment are the primary treatment of apparent uterine-confined endometrial carcinoma, unless patients desire (and are candidates for) fertility-sparing options. Select patients with metastatic endometrial carcinoma are also candidates for hysterectomy.

Endometrial carcinoma should be removed en bloc to optimize outcomes; intraperitoneal morcellation or tumor fragmentation should be avoided.

TH/BSO and lymph node assessment may be performed by any surgical route (eg, laparoscopic, robotic, vaginal, abdominal), although the standard in those with apparent uterine-confined disease is to perform the procedure via a minimally invasive approach.

The lymph node assessment includes evaluation of the nodal basins that drain the uterus, and often comprises a pelvic nodal dissection with or without aortic nodal dissection. This continues to be an important aspect of surgical staging in women with uterine-confined endometrial carcinoma, as the procedure provides important prognostic information that may alter treatment decisions.

Pelvic lymph nodes from the external iliac, internal iliac, obturator, and common iliac nodes are frequently removed for staging purposes.

Para-aortic nodal evaluation from the inframesenteric and infrarenal regions may also be utilized for staging in women with high-risk tumors such as deeply invasive lesions, high-grade histology, and tumors of serous carcinoma, clear cell carcinoma, or carcinosarcoma.

Excision of suspicious or enlarged lymph nodes in the pelvic or aortic regions is important to exclude nodal metastasis.

Visual evaluation of the peritoneal, diaphragmatic, and serosal surfaces with biopsy of any suspicious lesions is important to exclude extrauterine disease.

Omental biopsy is commonly performed in those with serous carcinoma, clear cell carcinoma, or carcinosarcoma histologies.

Reference

  • Wui-Jin K, Abu-Rustum NR, Bean S, et al. Uterine Neoplasms, Version 1.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2018 Feb;16(2):170-199. http://www.jnccn.org/content/16/2/170.long

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