Skip to main content
SpringerLink
Log in

Endometriumkarzinom

Aktuelle Diagnostik und Therapie

Endometrial cancer

Current diagnostics and therapy

  • Leitthema
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Das Endometriumkarzinom (EC) ist in Deutschland die vierthäufigste Krebsart bei Frauen. Es wird meist in einem frühen Stadium (pT1a, neue Klassifikation) und mit günstiger Histologie (endometrioid, G1, G2) symptomatisch. Hier ist die einfache Hysterektomie mit beidseitiger Adnexexstirpation eine sehr erfolgreiche Therapie. Bei höheren Stadien, höherem Grading und bei Typ-2-Karzinomen (serös, klarzellig) wird die zusätzliche pelvine und paraaortale Lymphonodektomie sowie, zur Verbesserung der lokalen Kontrolle, eine adjuvante Strahlentherapie empfohlen. Oft ist eine vaginale Brachytherapie ausreichend. Bei EC mit hohem Risiko für Fernmetastasen (G3, Typ 2 sowie in den Stadien III und IV) ist eine adjuvante platinhaltige Chemotherapie, ggf. in Kombination mit einer Strahlentherapie, sinnvoll. Diese Empfehlungen müssen jedoch in randomisierten Studien evaluiert werden.

Abstract

Endometrial cancer (EC) is the fourth most common malignant disease in women in Germany. Most cases of EC become symptomatic in an early stage (pT1a, new classification) and have favorable histological results (endometrioid, G1, G2). For these patients total hysterectomy and bilateral salpingo-oophorectomy is a highly successful treatment. For higher stages, higher grading, and type 2 EC (serous, clear cell), a systematic pelvic and para-aortic lymphadenectomy is recommended. Local control can be improved in these cases by additional radiotherapy. In many cases vaginal brachytherapy is sufficient. For EC with a high risk of distant metastases (G3, type 2, stages III and IV), an adjuvant platinum-based chemotherapy either alone or in combination with radiotherapy may be useful. These recommendations should be evaluated by randomized trials.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Chan JK, Wu H, Cheung MK et al (2007) The outcomes of 27,063 women with unstaged endometrioid uterine cancer. Gynecol Oncol 106:282–288

    Article  PubMed  Google Scholar 

  2. Chiva L, Lapuente F, Gonzalez-Cortijo L et al (2008) Sparing fertility in young patients with endometrialb cancer. Gynecol Oncol 111:S101–S104

    Article  PubMed  Google Scholar 

  3. Creasman WT, Odicino F, Maisonneuve P et al (2006) Carcinoma of the corpus uteri. FIGO 26th annual report on the results on treatment in gynecological cancer. Int J Gynaecol Obstet 95 (Suppl 1):S105–S143

    Article  PubMed  Google Scholar 

  4. DiSaia PJ (2010) Predicting parametrial involvement in endometrial cancer. Is this the end for radical hysterectomies in stage II endometrial cancers? Obstet Gynecol 116:1016–1017

    Article  PubMed  Google Scholar 

  5. Emons G (2009) Endometriumkarzinom. Gynakologe 42:799–811

    Article  Google Scholar 

  6. Emons G (2010) Endometriumkarzinom. Best practice onkologie 5:24–32

    Article  Google Scholar 

  7. Gehrig PA, Bae-Jump VL (2010) Primising novel therapies for the treatment of endometrial cancer. Gynecol Oncol 116:187–194

    Article  PubMed  CAS  Google Scholar 

  8. Hogberg T, Signorelli M, Freire de Oliveira C et al (2010) Sequential adjuvant chemotherapy and radiotherapy in endometrial cancer – Results from two randomised studies. Eur J Cancer 46:2422–2431

    Article  PubMed  CAS  Google Scholar 

  9. Horn LC, Schierle K, Schmidt D et al (2011) Aktuelle TNM/FIGO-Stadieneinteilung für das Zervix- und Endometriumkarzinom sowie maligne Müller-Mischtumoren. Pathologe 32:239–243

    Article  PubMed  Google Scholar 

  10. Jacobs I, Gentry-Maharaj A, Burnell M et al (2011) Sensitivity of transvaginal ultrasound screening for endometrial cancer in postmenopausal women: a case-control study with the UKCTOCS cohort. Lancet Oncol 12:38–48

    Article  PubMed  Google Scholar 

  11. Janda M, Gebski V, Brand A et al (2010) Quality of life after total laparoscopic hysterectomy versus total abdominal hysterectomy for stage I endometrial cancer (LACE): a randomised trial. Lancet Oncol 11:772–780

    Article  PubMed  Google Scholar 

  12. Kommission Uterus der Arbeitsgemeinschaft Gynäkologische Onkologie e. V (2008) Interdisziplinäre S2k-Leitlinie für die Diagnostik und Therapie des Endometriumkarzinoms. In: Kommission Uterus der Arbeitsgemeinschaft Gynäkologische Onkologie e.V, in der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe e.V, sowie in der Deutschen Krebsgesellschaft e.V (Hrsg) Leitlinien zum Zervixkarzinom, zum Endometriumkarzinom und zu den Trophoblasttumoren. Zuckschwerdt, München, S 73–126

  13. Kommission Uterus, Arbeitsgemeinschaft Gynäkologische Onkologie e. V (2011) Aktuelle Empfehlungen zur Diagnostik und Therapie des Endometriumkarzinoms. http://www.ago-online.org

  14. Kumar S, Sha JP, Bryant S et al (2009) Radiation-associated endometrial cancer. Obstet Gynecol 113:319–325

    PubMed  Google Scholar 

  15. Lacey JV Jr, Sherman ME, Rush BB et al (2010) Absolute risk of endometrial carcinoma during 20-year follow-up among women with endometrial hyperplasia. J Clin Oncol 28:788–792

    Article  PubMed  Google Scholar 

  16. Manchanda R, Menon U, Michaelson-Cohen R et al (2009) Hereditary non-polyposis colorectal cancer or Lynch syndrome: the gynaecological perspective. Curr Opin Obstet Gynecol 21:31–38

    Article  PubMed  Google Scholar 

  17. May K, Bryant A, Dickinson HO et al (2010) Lymphadenectomy for the management of endometrial cancer (Review). Cochrane Database of Systematic Reviews (1):CD 007585

    Google Scholar 

  18. Mourits MJE, Bijen CB, Arts HJ et al (2010) Safety of laparoscopy versus laparotomy in early-stage endometrial cancer: a randomised trial. Lancet Oncol 11:763–771

    Article  PubMed  Google Scholar 

  19. Nout RA, Smith VTHBM, Putter H et al (2010) Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non inferiority, randomised trial. Lancet 375:816–823

    Article  PubMed  CAS  Google Scholar 

  20. Robert-Koch-Institut und die Gesellschaft der epidemiologischen Krebsregister in Deutschland e. V. (Hrsg) (2010) Krebs in Deutschland 2005/2006. Häufigkeiten und Trends, 7. Ausgabe. Berlin

  21. Sorbe B, Nordström B, Mäenpää J et al (2009) Intravaginal brachytherapy in FIGO stage I low-risk endometrial cancer. A controlled randomized study. Int J Gynecol Cancer 19:873–878

    Article  PubMed  Google Scholar 

  22. Suh-Burgmann E, Hung YY, Armstrong MA (2009) Complex atypical endometrial hyperplasia. The risk of unrecognized adenocarcinoma and value of preoperative dilation and curettage. Obstet Gynecol 114:523–529

    Article  PubMed  Google Scholar 

  23. The ASTEC/EN.5 writing committee on behalf of the ASTEC/EN.5 Study Group (2009) Adjuvant external beam radiotherapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomised trials): pooled trial results, systematic review, and meta-analysis. Lancet 373:137–146

    Article  Google Scholar 

  24. Todo Y, Kato H, Kaneuchi M et al (2010) Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet 375:1165–1172

    Article  PubMed  Google Scholar 

  25. Hanegem N van, Breijer MC, Khan KS et al (2011) Diagnostic evaluation of the endometrium in postmenopausal bleeding: An evidence-based approach. Maturitas 68:155–164

    Article  PubMed  Google Scholar 

  26. Vergote I, Amant F, Timmerman D (2011) Should we screen for endometrial cancer? Lancet Oncol 12:4–5

    Article  PubMed  Google Scholar 

  27. Walker JL, Piedmonte MR, Spirtos NM et al (2009) Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. J Clin Oncol 27:5331–5336

    Article  PubMed  Google Scholar 

  28. Watanabe Y, Satou T, Nakai H et al (2010) Evaluation of parametrial spread in endometrial carcinoma. Obstet Gynecol 116:1027–1034

    Article  PubMed  Google Scholar 

  29. Wittekind C, Meyer HJ (Hrsg) (2010) TNM Klassifikation maligner Tumoren, 7. Aufl. Wiley-VCH, Weinheim

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Gynäkologie und Geburtshilfe, Georg-August-Universität Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland

    G. Emons, T. Hawighorst & M. Hellriegel

Authors
  1. G. Emons
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Hawighorst
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Hellriegel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Emons.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Emons, G., Hawighorst, T. & Hellriegel, M. Endometriumkarzinom. Gynäkologe 44, 701–707 (2011). https://doi.org/10.1007/s00129-011-2763-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00129-011-2763-1

Schlüsselwörter

Keywords

Search

Navigation