1. Management of endometrial cancer found on routine hysterectomy for benign disease
Prof Dr M Anıl Onan
MAY ANTALYA

7. Benign hysterectomy
Unexpected uterine malignancy incidence %
Unsuspected endometrial cancer incidence 0.12 %

11. What are the causes of incidental gynecologic malignancy. Ayhan A
What are the causes of incidental gynecologic malignancy? Ayhan A. et al.

12. Important Pathological Issues
Histologic type of tumor
Myometrial invasion
Grade
Low segment involvement
Tumor size
LVI
Surgical margines

13. What have to be done in case of incidental endometrial cancer?
With risk factors such as;
high grade endometrioid, serous, clear cell, undifferentiated, carcinosarcoma histology
MI> 50%
Cervical stromal invasion
LVI
Tumor diameter> 2 cm
“Chest/ Abdominopelvic CT” for metastatic disease
NCCN-2017

14. Management in Low Risk Group
Stage IA
Tm size < 2 cm Just Observe
Grade No LND
Endometrioid histology
SEER data LNM 1.4 % in 4095 patients

15. Based on gross and microscopic evaluation:
Endometrioid histology No LND
MI< 50% year OS 95.8%
Grade I / II DS death 1.1%
No cervical involvement
No intra-abdominal metastases

16. Complementary surgIcal stagIng excludIng stage Iag1 recurrence rate
DIsease –free survIval

17. 12333 LND(+) vs LND(-)
DSSurvival difference in stage I, G3 disease (90 vs 85%)(p<0.0001)
No difference in stage I, G1-2 disease (p=0.26)(p=0.14)

20. In conclusion, women receiving pelvic lymphadenectomy reported no clinically relevant better HRQL or fewer symptoms compared to women who received radiotherapy or no adjuvant treatment at all. Using lymphadenectomy to tailor external beam radiotherapy and prevent over-treatment in low-risk clinical early stage patients can therefore be debated. Especially since PORTEC-2 [7,14] publications will lead to increased use of brachytherapy and thus even less gastrointestinal symptoms in patients who receive RT when additional risk factors are found after surgery. In addition to the fact that there is no evidence
that pelvic lymphadenectomy decreases the risk of death or disease recurrence, pelvic lymphadenectomy cannot be recommended for stage I–II endometrial cancers.

32. Radiotherapy ?
Aalders J(1980) External RT reduced locoregional recurrence
more distant metastases
no OS benefit
Portec I, EBRT provided benefit for uterine- confined disease
reduced locoregional recurrence
ASTEC/EN .5 ; no improvement in RFS, PFS, OS
minimal benefit for pelvic control
GOG99 ; adj. Pelvic RT improved locoregional control and PFS
without any OS benefit
Not formally staged
Not formally staged
50 % staged
staged

33. Radiotherapy ? Portec 2, EBRT vs IVRT ;
Similar and excellent pelvic and vaginal control rates for uterine-confined disease
No OS benefit
IVRT has less toxicity and a reasonable method for uterine-confined disease
GOG240, high risk uterine-confined disease
IVRT+EBRT vs IVRT+Chemo
No OSurvival benefit with more toxicity in chemo group
PFS improved , distant metastases decreased

38. Take Home Messages
You can avoid incidental uterine malignancy by appropriate preoperative evaluation
Imaging by CT indicated especially patients with risk factors
In early stage without any/low risk factors, you can observe these patients
Restaging have to be done in patients with high risk factors
Except stage I; restaging and adjuvant therapy is mandatory