Advances in diagnosis, staging, and management of cervical and endometrial cancer, stages I and II

Abstract

The majority of patients with low stage cervical and endometrial cancer are cured. Results obtained in the past only in the categorical cancer centers are currently being achieved more broadly. This reflects the work of formally trained gynecologic oncologists often in collaboration with formally trained radiation therapists distributing themselves in a horizontal fashion to more and more university medical centers, teaching hospitals, and quality tertiary hospitals in the private sector. The formalization of training in gynecologic oncology has been pivotal in this development. This group of physicians, working with physicians in other disciplines, have impacted significantly on patient care and have provided many clinical and pathologic studies to better define favorable low stage cases and poor prognosis cases. The need to explore the use of currently available modalities in a variety of different combinations and to define and develop new techniques to apply to these poor prognosis subsets of disease represent areas of progress and challenge.

Usefulness of DWI in preoperative assessment of deep myometrial invasion in patients with endometrial carcinoma: a systematic review and meta-analysis

“…It is not clear if there is an independent prognostic variable [ 4 ],[ 6 ]. In particular, histological tumor grade and depth of myometrial invasion strongly correlate with the presence of lymph node metastases and overall patient survival [ 7 ]. The incidence of lymph node metastases increases from 3% with superficial myometrial invasion to 46% with deep myometrial invasion [ 8 ],[ 9 ].…”

Myometrial invasion in endometrial cancer: diagnostic performance of diffusion-weighted MR imaging at 1.5-T

“…The prognosis of endometrial cancer mainly depends on three factors: histological subtype and grade, tumour stage at diagnosis, including the depth of myometrial invasion, and the presence of lymph node metastases [4]. In particular, histological tumour grade and depth of myometrial invasion strongly correlate with the presence of lymph node metastases and overall patient survival [5]. Patients with 50% or greater myometrial invasion have a six-to seven-fold higher prevalence of pelvic and para-aortic lymph node metastasis compared with patients in whom myometrial invasion is absent or less than 50% [6].…”

Endometrial Cancer

“…There is still no consensus on whether complete surgical staging with primary pelvic and para-aortic lymphadenopathy should be performed at stage I, namely, in patients with low recurrence risk (Bonatti et al 2015;Todo et al 2010;May et al 2010). However, it is known that the tumor histological type and grade, the presence of myometrial invasion ≥50 %, and the presence of lymphovascular space invasion correlate with the presence of lymph node metastasis and with overall survival (Rechichi et al 2010;Sala et al 2013;Boronow 1990;Larson et al 1996). From these features, only the histological type and grade can be assessed preoperatively without imaging.…”