Probability of recurrence of early endometrial cancer

Endometrial cancer can be divided into 5 stages according to the extent of tumor invasion: Stage 0 is suspected cancer or carcinoma in situ; Stage I is cancer confined to the uterine body; Stage Ia is uterine cavity length <8 cm; Stage Ib is uterine length >8 cm; Stage II is cancer invading the cervical canal; Stage IV is cancer extending beyond the uterus but not beyond the pelvic cavity;

The combination of radiotherapy and surgery has been a controversial issue over the years but has not yet been completely resolved.

Some scholars believe that preoperative radiotherapy can improve the 5-year survival rate, while others hold a negative opinion. The benefits of preoperative radiotherapy are: ① It can reduce the size of the tumor, which is conducive to surgery; ② It can inactivate cancer cells and reduce the possibility of postoperative recurrence and distant metastasis; ③ It can reduce the chance of infection. Therefore, it can improve the surgical cure rate. Therefore, if there are people who speculate on radiotherapy, they can consider using it.

For patients whose cancer has deeply infiltrated the myometrium and whose cells are poorly differentiated, intracavitary radiotherapy should be used before surgery, and external irradiation should be used after surgery. In view of the above advantages, for patients who have the conditions for radiotherapy and need preoperative radiotherapy, radiotherapy plus surgery is still appropriate. For stage I cancer with a uterus smaller than normal, and the patient has limited surgery time due to some reasons, hysterectomy can be performed first, and the uterine specimen can be dissected to determine whether there is myometrial invasion.

Of course, sometimes it is difficult to judge the specimen. The following subtle changes can be noted under the microscope: ① The glands infiltrated by cancer in the myometrium are serrated and irregular in shape, while the glands in the basal layer are round and have no corners; ② There is no endometrial stroma around the glands infiltrated by cancer, while the glands in the basal layer are often surrounded by endometrial stroma; ③ There is obvious edema around the infiltrated foci of cancer. In 1972, Milton compared the 5-year survival rates of total hysterectomy and sub-extensive hysterectomy (without lymph node dissection). The former was 75% and the latter was 91%. This suggests that expanding the scope of hysterectomy (at least sub-extensive hysterectomy) helps reduce the postoperative recurrence rate.