Stage IA endometrial cancer

Written by Li Lin
Obstetrics and Gynecology
Updated on September 14, 2024
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Endometrial cancer is a group of epithelial malignant tumors that occur in the endometrium. Clinically, the surgical pathology staging revised by the World Health Organization in 2000 is mainly used, based on the severity of the lesion after surgery. Endometrial cancer can be divided into four stages, where, depending on the size and severity of the lesion, it can further be classified into sub-stages a, b, and c. Stage IA refers to cancer limited to the endometrium and is the earliest stage of endometrial cancer. Stage IA endometrial cancer can be completely cured with surgical treatment.

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Is endometrial hyperplasia cancer?

Endometrial hyperplasia is not cancer; the normal endometrial lining is in a proliferative state. Endometrial hyperplasia occurs due to a lack of secretion of progesterone. If it continues to develop, it can progress to atypical endometrial hyperplasia, which is a precancerous condition of the endometrium. If not treated in time, it could develop into endometrial cancer. Thus, active treatment of endometrial hyperplasia is necessary. Large doses of progesterone can be used to promote the transformation of the endometrial lining. Once the endometrium transforms into the secretory phase, it indicates that the endometrial hyperplasia has been effectively treated and can prevent the progression to endometrial cancer.

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How is endometrial cancer staged?

Endometrial cancer is a common gynecological malignancy in women. Based on surgical and pathological results, endometrial cancer can be divided into four stages. Stage I is the mildest form of endometrial cancer, where the cancer is confined only within the endometrium and does not extend beyond the uterine serosa. Generally, stage 1a is when the cancer is less than half the width of the muscle, while stage 1b is when the cancer infiltrates more than half the width of the muscle. Stage II means the cancer has locally spread but only involves the cervix, without causing cervical stromal infiltration. Stage III involves local spread to the serosa and lymph nodes. Stage IV involves distant metastasis, such as to the liver and bones.

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How to perform surgery for endometrial cancer

Surgical treatment for endometrial cancer needs to be determined based on the specific stage and type of the cancer, as well as the size of the lesions. If the lesions are small and the cancer is in an early stage, a complete hysterectomy including the removal of both fallopian tubes and ovaries can be performed. Intraoperative pathology assessment of the endometrium is also necessary to determine the specific pathological type. If it is a special type of endometrial cancer, it is also necessary to clear the pelvic lymph nodes. If the endometrial cancer is at a later stage and the lesions are larger, then in addition to the removal of the uterus and both fallopian tubes and ovaries, it is also necessary to clear the lymph nodes around the abdominal aorta in the pelvis.

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Stage IB endometrial cancer treatment

Endometrial carcinoma Stage IB refers to tumors localized to the body of the uterus, where tumor infiltration is less than half of the myometrium. Surgical treatment is feasible for this stage and involves a slightly extensive total hysterectomy coupled with bilateral adnexectomy. During the surgery, a frozen section pathology test should be conducted. If the pathology report from the frozen section indicates special types of endometrial-like cancer, including papillary serous adenocarcinoma, clear cell carcinoma, squamous cell carcinoma, carcinosarcoma, and undifferentiated carcinoma, additional procedures are required. Moreover, if enlarged para-aortic or common iliac lymph nodes are palpated during the surgery, lymphadenectomy of the pelvic and para-aortic lymph nodes should be performed.

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Endometrial cancer requires chemotherapy.

If endometrial cancer has high-risk factors, chemotherapy is needed after surgery if these high-risk factors are found in the pathological staging. If it's early-stage endometrial cancer without these high-risk factors, chemotherapy might not be necessary after surgery because chemotherapy also serves to prevent recurrence and metastasis. Therefore, it is advised that patients with high-risk factors in endometrial cancer undergo chemotherapy. Although chemotherapy may have significant side effects, it can improve the survival time and quality of life for cancer patients. The decision to proceed with chemotherapy should be based on the postoperative pathological staging, biopsy results, and the presence or absence of factors like lymph node metastasis.