MANAGEMENT OF ENDOMETRIAL CANCER

Preoperative assessment requires only endometrial sampling for diagnos is. Curettage is needed when endometrial sampling is unsatisfactory. T ransvaginal ultrasonography may be useful in screening high-risk patie nts, as well as in assessing myoinvasion or cervical extension. Postsu rgical pathologic prognostic factor analysis is most accurate in assig ning risk for recurrence. Once the extent of disease is confirmed by t he surgical staging procedure of hysterectomy bilateral removal of the ovaries, and selective pelvic and periaortic node dissection, adjunct ive therapy can be considered. Patients with low-risk stage IA and IB grade 1 disease require hysterectomy and removal of the adnexa. The po orer prognosis of patients with grade 2 or 3 histologic features in st ages IB to IIB dictates considerations for adjunctive therapy. Soon ra ndomized controlled trials will elucidate objectively what may be opti mal adjunctive therapy. On-going prospective trials will clarify the r ole of operative laparoscopy. Current management guidelines are based on independent prognostic factors derived from analysis of surgicopath ologic studies.