What is a good treatment for endometrial cancer

Endometrial cancer is a common gynecological malignancy. The treatment of this disease should be determined based on the size of the uterus, whether the myometrium is infiltrated by cancer, whether the cervical canal is involved, the degree of differentiation of cancer cells, and the patient's general condition. The main treatments are surgery, radiotherapy, and drug therapy, which can be used alone or in combination.

1. Surgery is the preferred treatment method, especially for early cases. Patients in stage I should undergo subradical hysterectomy and bilateral salpingo-oophorectomy. Those with one of the following conditions should undergo pelvic and para-aortic lymph node sampling and/or dissection: ① The pathological type is clear cell carcinoma, serous carcinoma, squamous cell carcinoma or G3 endometrioid carcinoma. ② The depth of invasion of the muscle layer is ≥1/2. ③ The tumor diameter is >2cm. In stage II, extensive hysterectomy and bilateral pelvic and para-aortic lymph node dissection should be performed. Ascites should be taken immediately after entering the abdominal cavity. If there is no ascites, 200ml of normal saline should be injected to flush the abdominal cavity. The ascites or peritoneal washings should be centrifuged and precipitated to find cancer cells.

2. Surgery plus radiotherapy: For patients in stage I, if cancer cells are found in the ascites or the deep muscle layer has been infiltrated, and the lymph nodes are suspicious or have metastasized, radiotherapy is required after surgery, 60Co or linear accelerator external irradiation. Patients in stages III and IV can receive intracavitary irradiation or external irradiation before surgery, depending on the size of the lesion. Surgery should be performed within 1 to 2 weeks after the end of intracavitary radiotherapy. Surgery should be performed 4 weeks after the end of external irradiation.

3. Radiotherapy Although adenocarcinoma is not sensitive to radiation, it can be considered for the elderly or those with severe complications who cannot tolerate surgery and those who are not suitable for surgery in stage III and IV. It still has a certain effect. Radiotherapy should include intracavitary irradiation and external irradiation. Intracavitary irradiation often uses 137Cs, 60Co, etc., and external irradiation often uses 60Co and linear accelerators. Ra has been abandoned.

4. Progestin therapy can be considered for patients with advanced or recurrent cancer, those who cannot undergo surgical resection or are young, early-stage, and those who require the preservation of fertility. Various synthetic progestin preparations such as medroxyprogesterone and progesterone caproate can be used. The dosage should be large, medroxyprogesterone 200-400mg/d; progesterone caproate 500mg, twice a week, at least 10-12 weeks to evaluate whether there is any effect. Its mechanism of action may be to act directly on cancer cells, delay the replication of DNA and RNA, and thus inhibit the growth of cancer cells. Progesterone therapy is more effective for endometrial cancer with good differentiation, slow growth, and high estrogen and progesterone receptor content. The side effects are mild, which can cause water and sodium retention, edema, drug-induced hepatitis, etc., and gradually improve after stopping the drug.

5. Anti-estrogen treatment Tamoxifen is a non-steroidal anti-estrogen drug with a weak estrogen effect. It can also be used to treat endometrial cancer. Its indications are the same as those for progesterone therapy. The general dose is 10-20 mg, taken orally twice a day, for long-term or divided courses. Tamoxifen has the effect of increasing the level of progesterone receptors. Patients with low receptor levels can first take tamoxifen to increase the level of progesterone receptors, and then use progesterone treatment or both at the same time to improve the efficacy. Side effects include hot flashes, chills, irritability and other manifestations similar to perimenopausal syndrome; bone marrow suppression is manifested by decreased white blood cell and platelet counts; other side effects may include dizziness, nausea, vomiting, irregular vaginal bleeding, amenorrhea, etc.

6. Chemotherapy can be considered for patients who are in the late stage and cannot undergo surgery or who relapse after treatment. Commonly used chemotherapy drugs include doxorubicin, fluorouracil (5-FU), cyclophosphamide (CTX), mitomycin (MMC), etc.; they can be used alone, in combination with several drugs, or in combination with progesterone.