Uterine Cancer (eBook)

Preface 6
Contents 8
Contributors 10
The Essential Epidemiology of Cancer of the Endometrium 13
Introduction 14
Estrogen Dose and Endometrial Cell Mitotic Rate 14
Body Mass Index 16
Menopausal Hormone Therapy 16
Menopause 19
Parity 20
Oral Contraceptives 20
Chemoprevention 21
Conclusions 21
References 22
Endometrial Cancer: Screening, Diagnosis, and Surgical Staging 25
Screening 25
Diagnostic Tests 28
Surgical Staging 31
Operative Techniques for Staging 33
Conclusions 34
References 35
Imaging in the Diagnosis and Treatment of Endometrial Cancer 37
Introduction 37
Ultrasound 37
Sonohysterography 43
Doppler Ultrasound 43
Magnetic Resonance Imaging 45
Computed Tomography 52
Positron Emission Tomography 54
Post-treatment Surveillance 58
Conclusions 59
References 59
Uterine Cancer: Pathology 63
Endometrial Carcinoma and Precursor Lesions 64
Uterine Sarcomas and Mixed Müllerian Tumors 75
Conclusions 90
References 91
Molecular Pathology and Cytogenetics of Endometrial Carcinoma, Carcinosarcoma, and Uterine Sarcomas 99
Endometrial Carcinoma 99
Uterine Carcinosarcomas (Malignant Mixed Müllerian Tumors) 108
Uterine Sarcomas 109
Low-Grade Endometrial Stromal Sarcomas 110
Conclusions 111
References 112
Prognostic Factors in Uterine Cancer 117
Endometrial Carcinoma 117
Conclusions 140
References 141
Primary Hormonal Therapy of Endometrial Cancer 154
Introduction 154
Epidemiology (see also chapter 1) 155
Complex Atypical Hyperplasia in Women Under 40 Years 157
Data Supporting Hormonal Therapy 159
Mechanisms of Hormone Receptor Action in Endometrial Cancer 164
Conclusions 166
References 167
Early-Stage Endometrial Cancer: Surgery 172
Introduction 172
Surgical Therapy 173
Conclusions 180
References 181
Early-Stage Endometrial Cancer: Radiation 185
Introduction 185
Definition of Low and Intermediate Risk 186
Conservative Management 186
Adjuvant Radiotherapy 187
Selection of High-Dose Rate Applicators 196
Sequelae of Radiotherapy 198
Conclusions 199
References 199
Therapeutic Modalities in Early-Stage Uterine Papillary Serous Carcinomas, Carcinosarcomas, Clear-Cell and Mixed Histology Carcinomas: Building a Case for Combined Chemotherapy and Radiation 203
Introduction 203
Papillary Serous Carcinoma 204
Carcinosarcoma 211
Clear Cell Carcinoma and Tumors of Mixed Histology 220
Conclusions 222
References 222
Treatment of Advanced and Recurrent Carcinoma: Hormonal Therapy 227
Introduction 227
Clinical Experience (1961–2000) 227
Current Status of Hormonal Therapy 228
Future Directions 230
Conclusions 231
References 231
Treatment of Advanced and Recurrent Carcinoma: Chemotherapy 233
Introduction 233
Single Agent Chemotherapy 234
Combination Chemotherapy 236
Adjuvant Chemotherapy 237
Carcinosarcomas 239
New Directions 239
Conclusions 240
References 241
Treatment for Advanced and Recurrent Carcinoma: Combined Modalities 246
Introduction 246
Radiation Therapy for Locally Recurrent Endometrial Cancer 247
Surgery for Stage IV and Recurrent Endometrial Cancer 248
Advanced Stage Endometrial Cancer 249
Combination Hormonal Therapy 252
Combination Chemohormonal Therapy 253
Conclusions 254
References 255
Management of Uterine Sarcomas 259
Introduction 259
Initial Surgical Management of Early-Stage Uterine Sarcomas 260
Role of Adjuvant Therapies 261
Treatment of Recurrent Disease 263
Conclusions 269
References 269
Future Directions: New Targets 274
Introduction 274
Integration of Chemotherapy in Early Stages 275
Identifying Potential Molecular Targets 276
Exploration of Current “Targeted” Therapies 280
Conclusions 285
References 285
Index 291