Adenocarcinoma of the Body of the Uterus

Abstract

AND SummaryA series of 129 cases of adenocarcinoma of the uterus treated by Wertheim's hysterectomy and lymphadenectomy is reported. Preoperative radium was given together with postoperative irradiation when pelvic lymph nodes were involved in metastatic cancer. The five-year survival was 71 -5 per cent. This figure rose to 74 per cent when the growth did not involve the cervix. The incidence of lymph node involvement was 13-2 per cent, or 11.2 per cent when the cervix was free from growth. The incidence of node involvement was related to the degree of differentiation of the tumour and the depth of myometrial invasion. Thirty-six per cent of patients with positive nodes survived 5 years when lymphadenectomy was combined with external radiation. When death occurred the metastatic deposits were usually outside the pelvis. It is concluded that lymphadenectomy need be performed only in patients with poorly differentiated and deeply invasive growth. Postoperative external irradiation is indicated if the nodes contain cancer.

Radical Surgery in Stage I Carcinoma of the Corpus Uteri

“…The frequency of pelvic lymph node metastases (18%) observed in this study of corpus carcinomas stage I is higher than in most other reports (Lees, 1969;Morrow et al, 1973;Creasman et al, 1976;Lewis et al, 1970). This high incidence might be due to meticulous dissection and peroperative guidance from lymphography.…”

“…It is therefore dificult to decide whether lymphadenectomy should be performed. Some authors recommend simple hysterectomy and bilateral salpingooophorectomy (Bergsjar and Nilsen, 1966 ;Nilsen and Koller, 1969 ; Frick I1 et a/, 1973 ; Rutledge, 1974) often combined with radiotherapy, while others (Lewis et al, 1970) advocate radical hysterectomy and pelvic lymphadenectomy in patients with poorly differentiated and deeply invasive tumours.…”

Preoperative Transvaginal Ultrasonography and Intraoperative Gross Examination for Assessing Myometrial Invasion by Endometrial Cancer

“…In addition, lymphadenectomy is not entirely risk free and may lead to severe complica- tions, such as lymphocysts, bleeding, and ureteral and vascular damage. 8 Lagasse et al 9 reported gastrointestinal and urogenital complication rates of 1.6% intraoperatively and 2.9% postoperatively with lumboaortic lymphadenectomy. A preoperative distinction between patients with stage Ia-Ib carcinoma and patients with stage Ic carcinoma would allow identification of high-risk patients who might benefit from pelvic lymphadenectomy.…”

Ultrasonic assessment of endometrial cancer invasion

“…The 5-year survival rate of endometrial cancer is related to the degree of myometrial invasion, ranging from 93.7% when no invasion is present and 88.1 % when only the superficial layers of the myometrium are involved, to 36.2% if the invasion is deep. 13 Similarly, the frequency of pelvic node metastasis rises from 3.4% to 14.4% when deep myometrial invasion is present. Also, endometrial cancer limited to stage I has a low 5-year survival rate in the case of deep myometrial invasion (61%).14 In this study ultrasonography was accurate in detecting the degree of myometrial invasion in 80% of the cases.…”