What is the surgical treatment of endometrial cancer?

The mainstay is total hysterectomy and bilateral salpingo-oophorectomy (removing the uterus, cervix, tubes and ovaries), with peritoneal washings and assessment of lymph nodes.

For higher-risk/type 2 disease, this is extended to include pelvic (+/- para-aortic) lymphadenectomy. Surgery also provides surgical staging to guide adjuvant treatment.

Clinical relevance. Hysterectomy with BSO (plus lymph node assessment in higher-risk disease) treats and stages endometrial cancer.

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Surgical treatment of endometrial cancer

Surgery is both therapeutic and the means of staging.

Standard surgery

• Total hysterectomy and bilateral salpingo-oophorectomy (TH+BSO) - removing the uterus, cervix, fallopian tubes, and ovaries.
• Peritoneal washings and inspection of the peritoneal cavity.
• Often performed laparoscopically/minimally invasively for early-stage disease.

Lymph node assessment

• Pelvic (+/- para-aortic) lymphadenectomy (or sentinel node biopsy) - especially for higher-grade or type 2 disease (e.g. grade 3 endometrioid or serous/clear cell), to assess nodal spread.
• Low-risk early disease may not need full lymphadenectomy.

Role in staging

• Surgery provides surgical staging (depth of invasion, grade, nodes) that determines adjuvant treatment.

Note

• Fertility-sparing progestogen treatment is occasionally considered in young women with early grade-1 disease.