) is performed via the vaginal route or laparotomy , with the removal of the ovaries as well, tubes and a piece of vagina of about 2 centimeters. All preceded by the sampling of the peritoneal fluid.
In stage II, when the tumor has spread to the neck of the uterus, radiotherapy is performed inside the uterus and vagina (intracavitary) in full doses before surgery. After six weeks the operation is carried out, which consists of a radical hysterectomy with bilateral removal of the ovaries, tubes and lymph nodes. If the lymph nodes are affected by metastases , the operation is followed by post- pelvic surgery radiotherapy plus chemotherapy .
In stage III, in which the cancer has left the uterus but is still confined to the ovaries and/or the vagina and/or there are lymph node metastases, first external, then intracavitary radiotherapy is performed, in order, and, after 6 weeks, surgery, followed by postoperative radiotherapy and chemotherapy.
Stage IV, which fortunately is diagnosed rather rarely, can be treated in various ways; none of these can lead to complete cure of the disease but only to a reduction in pain and an increase in survival. Intracavitary uterine and vaginal radiotherapy can be performed alone, which has the sole purpose of reducing pain and vaginal bleeding. Even external radiation therapyit has the same purpose. Furthermore, many of these patients can be treated with aggressive chemotherapy and/or high doses of progesterone .
Survival – Periodic Checks (Follow-Up) – Relapses
The 5-year survival for patients with endometrial cancer is greatly influenced by the presence or absence of factors such as: lymph node involvement, degree of tumor differentiation, penetration into the myometrium, type of tumor (more or less aggressive), positive peritoneal fluid to malignant cells, tumor volume and patient age. In principle, it can be stated that the 5-year survival in patients undergoing surgical treatment is as follows:
Stage 0 = 100%
Stage I = 72-98%
Stage II = 30-75%
Stage III = 15-60%
Stage IV = 3-10%
Many of these patients, after the fifth year, do not present any clinical, radiological or otherwise ascertained signs of the disease. In this case, the abbreviation NED (No Evidence of Disease) will be used. A certain number of them (10-15%), on the other hand, die of illness in the second five-year period.
It should also be remembered that a certain number of patients do not die of cancer but, given their advanced age , die of another intercurrent disease.
The patient treated and operated on for endometrial carcinoma must be checked every 4 months in the first, second and third year, every 6 months from the fourth to the tenth year and then once a year for life. The control must be clinical ( gynecological examination ), ultrasound and cytological (withdrawal with biopsy and analysis under the microscope). Every two years, for the first six years, a CT scan of the abdomen and pelvis should be performed .
Other tests will be requested if there is a suspicion of recurrence.
They are local (vaginal) in 20% of cases, central pelvic (that is, they reach the bottom of the vagina) and parietal pelvic (lymph nodes). In about 70% of recurrences, bleeding from the vagina appears, while in 30% there are no early symptoms. 75% of recurrences appear within the first three years of therapy.
There is a surveillance scheme to arrive at the early diagnosis of recurrence; it includes the vaginal cytological examination, the dosage of the CA 125 marker (a protein produced by the tumor, especially by its recurrences, and which increases in the blood in these two cases) and the search for hidden symptoms. A chest X-ray and a CT scan of the abdomen and pelvis should be done every 6-12 months for three years .
According to certain statistics, vaginal recurrences can decrease, either thanks to intracavitary radiotherapy done before the operation, or to vaginal radiotherapy done after it. Another aspect to bear in mind is that, from the point of view of prognosis, the earlier a recurrence is identified, the more one can hope to treat it successfully.