Endometrial malignancy.

Abstract

This article reviews published papers on endometrial carcinoma from August 1989 to July 1990. The hypothesis of two different pathogenic types of endometrial carcinoma, which are well correlated with favorable and unfavorable prognosis, has been established. The prognosis for patients under 21 years of age with well-differentiated endometrial carcinoma is excellent; for them, a conservative, fertility-preserving treatment is possible. The characteristics of carcinomas with unfavorable prognoses are also discussed. These prognostic factors are measurable in tissue from preoperative curettage. Measurement of myometrial invasion by vaginal sonography and nuclear magnetic resonance imaging is possible with a high degree of safety preoperatively as well. At least intraoperatively, an exact measurement of depth of invasion can be obtained by frozen-section diagnosis. In an optimal preoperative examination, it should be possible to select patients with a high rate of metastases for intraoperative lymphadenectomy. For adjuvant postoperative therapy, percutaneous radiotherapy is indicated in high-risk patients in whom no optimal lymphadenectomy has been done. Vaginal irradiation, however, used in all cases up until now, is known to bring about more local complaints. Adjuvant progestagen treatment in low-risk patients is dangerous because it can cause a higher rate of cardiovascular disease and does not reduce death by recurrent disease. The profit for high-risk patients seems very small. Analysis of endometrial carcinoma tissue shows a high rate of receptors for luteinizing hormone-releasing hormone and analogues. Adjuvant chemotherapy in high-risk patients until now has been without measurable effect.