Serum endometrium carcinoma accounts for only 5 to 10% of endometrial cancer cases, but is responsible for 39% of deaths from the disease. Among the predisposing factors that are of particular importance for its occurrence are the individual history of breast cancer and tamoxifen use, as well as mutations in the BRCA1 / 2 genes. Today, thanks to important scientific developments in this field, patients with endometrial carcinoma can hope for a much better future.
What is new in the treatment of endometrial serum carcinoma?
Serum endometrial carcinoma often gives rise to lymph node metastases, even when the tumor is quite limited inside the uterus. In this context, in cases where imaging is reassuring for distant foci of the disease, the classic surgical treatment of patients involves the performance of total hysterectomy after the fallopian tubes and ovaries, epilectomy, pelvic and paraortic lymphadenectomy.
Newer data, however, establish the value of the sentinel lymph node technique in endometrial serum carcinoma.
More specifically, the results of the prospective, multicenter SENTOR study revealed that the sentinel lymph node technique has a 99% sensitivity in the diagnosis of lymph node metastases in aggressive types of endometrial cancer. Furthermore, the internationally renowned Memorial Sloan Kettering Cancer Center in New York showed that patients with endometrial serous carcinoma undergoing the sentinel lymph node technique had similar survival rates to those who resorted to conventional pelvic and paraortic lymph nodes. Already, international guidelines for the treatment of endometrial cancer (NCCN, ESGO) include the sentinel lymph node technique among the options for patients with serous carcinoma.
What additional benefits does surgery with the lymph node-guard technique give patients?
The treatment of patients with serous endometrial carcinoma with the sentinel lymph node technique and the methods of minimally invasive surgery, such as robotics, ensures:
– the least chance of complications during surgery (eg vascular and nerve injuries).
– minimizing the risk of lymphedema and lymphocytes postoperatively.
– less blood loss.
– the lowest probability of infections of the surgical wound or postoperative hernia.
– the dramatic reduction of postoperative pain.
– faster recovery of patients. It is characteristic that very often hospitalization is required for only 24 hours.
– the best aesthetic result in the area of ​​the incisions.
Are there any newer drugs for endometrial carcinoma?
Chemotherapy and radiation therapy after initial surgery are extremely common in endometrial serum carcinoma due to the aggressiveness of the disease. In the advanced stages or relapses, we now have targeted treatments in our quiver.
More specifically, when tumors express HER2, trastuzumab administration is associated with better survival rates. Furthermore, given that endometrial serum carcinoma does not have the immunogenicity shown by other forms of the disease, immunotherapy with pembrolizumab and lenvatinib contributes significantly to improving the prognosis of patients who relapse. There are other newer drugs that are being tested in studies in the current period and we are waiting for their results with particular interest.
Writes:
Vassilios Sioulas
Gynecological Surgeon
Director of the 1st Clinic of Gynecological Oncology MITERA
President of the Scientific Council MITERA
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