Endometrial carcinoma: Adjuvant locoregional therapy

Four thousand new cases of endometrial carcinoma are registered in England and Wales each year. The incidence, increasing in line with the number of elderly women in society, currently stands at 12 per 100000 per annum [1]. In the United States, it is the most common gynaecological malignancy, but in the UK it is, presently, similar in incidence to cervical and ovarian carcinoma. The mortality rate of 30% [2,3] is, however, very much lower than in patients with carcinoma of the cervix (50%) or ovary (85%). This is because patients present at an earlier stage (75% with FIGO Stage I disease), the predominant symptom often being postmenopausal vaginal bleeding, a symptom that is seldom ignored. The primary treatment is total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO). In the UK, a lymphadenectomy is generally not performed. The usual management of the pelvic lymph nodes consists of intraoperative inspection and postoperative radiotherapy for those patients most at risk, the risk assessment being based on predictive factors for node positivity, local relapse and survival. This article discusses the supportive evidence, rationale and future direction of such a policy. Table 1. Incidence of positive pelvic lymph nodes in patients with stage I, II and III endometrial carcinoma: summary of three lymphadenectomy series [4-6]