Endometrial Cancer: Risk Factors, Management and Prognosis (Cancer Etiology, Diagnosis and Treatments)

Description

Endometrial cancer is the most common gynecological cancer and the sixth cause of cancer in developed countries. The findings that EC is a heterogeneous group of tumors with distinct risk factors and histopathological features, together with our improved understanding of its molecular mechanism has paved the way to the investigation of new surgical and medical therapies. The aim of this book is to give a complete overview on risk factors, pre-operative methods and management of endometrial cancer. The authors hope that this book will be a useful tool for any health provider involved in gynecological cancer care. (Nova Medicine and Health) Contents Introduction Chapter 1 Epidemiology and Risk Factors Abstract 1. Epidemiology 2. Type I and II Endometrial Cancer 2.1. Endometrioid Adenocarcinoma 2.2. Serous Papillary Adenocarcinoma 2.3. Clear Cell Adenocarcinoma 2.4. Undifferentiated Carcinoma 3. Risk Factors 3.1. Older Age 3.2. Overweight and Obesity 3.3. Metabolic Syndrome 3.4. Wrong Dietary Habits 3.5. Gynecological Diseases 3.6. Type 2 Diabetes Mellitus 3.7. Ethnic Group 3.8. Family History of EC 3.9. Menstrual and Reproductive Factors 3.10. Genetic Factors 3.10.1. MMR System Alterations (Not Syndrome-Related) 3.10.2. Lynch Syndrome (or Hereditary Non-Polyposis Colorectal Cancer or HNPCC 3.10.3. Cowden Syndrome (CS) and Cowden Syndrome Like (CSL) 3.10.4. HBOC (Hereditary Breast and Ovarian Cancer) Syndrome 3.10.5. RAD51 G135C Polymorphism 4. Protective Factors References Chapter 2 Molecular Pathology of Endometrial Carcinoma and Its Histopathological Correlations: Beyond a Dualistic Vision? Abstract 1. Introduction 2. Molecular Classification of Endometrial Carcinoma 3. Molecular Biology of Endometrial Carcinoma 3.1. Estrogen Receptors 3.2. Progesterone Receptors 3.3. PTEN 3.4. PIK3CA 3.5. β Catenin 3.6. E Cadherin 3.7. B-Cell Lymphoma 2 3.8. Cyclin D1 3.9. K-RAS 3.10. P53 3.11. P16 3.12. HER 2/NEU 3.13. Ki67 3.14. IMP3 3.15. ARID1A 3.16. C-MYC 3.17. Angiogenic Factors 3.18. FGFR2 3.19. HGF and CMET 3.20. Microsatellite Instability 4. Correlations between Major Histological Types and Molecular Pattern 5. Progression Pathways 5.1. Endometrioid Carcinoma 5.2. Non-Endometrioid Carcinoma (NEC) 6. Genomic Classification 6.1. Class 1: Ultra Mutated POLE 6.2. Class 2: Microsatellite Instability 6.3. Class 3: Endometrioid Tumors with Low Copy Number 6.4. Class 4: Tumors “Serous Like” with High Number of Copies References Chapter 3 Histopathological Classification Abstract 1. Introduction 2. Endometrioid Adenocarcinomas 2.1. Variants of Endometrioid Histotype 2.1.1. Villoglandular Carcinoma 2.1.2. Secretory Carcinoma 2.1.3. Ciliated Carcinoma 2.1.4. Endometrioid Carcinoma with Squamous Differentiation 2.1.5. Mucinous Carcinoma 3. Non-Endometrioid Carcinomas 3.1. Serous Carcinoma 3.2. Clear Cell Carcinoma 4. Undifferentiated and Dedifferentiated Endometrial Carcinomas 4.1. Mixed Carcinoma 4.2. Carcinosarcoma MMMT (Malignant Mϋllerian Mixed Tumor) 4.3. Squamous Carcinoma References Chapter 4 Clinical Presentation and Transvaginal Ultrasound Assessment Abstract 1. Introduction 2. The Role of Transvaginal Ultrasound Conclusion References Chapter 5 Radiological Assessment Abstract 1. The Role of Radiology in Endometrial Cancer Evaluation 2. Computed Tomography 3. Direct and Contrast-Enhanced Magnetic Resonance Imaging 3.1. Diffusion Weighted MRI (DWI-MRI) 3.2. Perfusion 3.3. BOLD-MRI 3.4. 3T MRI 3.5. MRI in Staging Endometrial Cancer 3.5.1. Stage I 3.5.2. Stage II 3.5.3. Stage III 3.5.4. Stage IV 4. PET-CT Conclusion References Chapter 6 Surgical Management of Early Stage Endometrial Cancer Abstract 1. Introduction 2. Endometrial Cancer in Young Women: Surgical Treatment Options 3. Guidelines for Treating Endometrial Cancer Patients with International Federation of Gynecology and Obstetrics (FIGO) Stage I 4. Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy (TAH-BSO) 5. Vaginal Hysterectomy (VH) 6. Laparoscopic Assisted Vaginal Hysterectomy (LAVH) and Total Laparoscopic Hysterectomy (TLH) 7. Laparoscopic Treatment 8. Robot-Assisted Treatment 9. Comparison between Laparoscopy and Robotic-Assisted Surgery 10. The Role of Lymphadenectomy in Surgery for Early Stage Endometrial Cancer 11. Clinical Recommendation Guidelines for Endometrial Cancer in FIGO Stage II 12. Sentinel Node (SN) Detection in Early Stage Endometrial Cancer 13. Complications of Surgical Treatments for Early Stage of Endometrial Cancer 13.1. Lymphocele 13.2. Urinary Tract Injuries 14. Obesity and Endometrial Cancer 15. Controversies in the Management of Early Stage Endometrial Cancer Conclusion References Chapter 7 A Newer Perspective in the Surgical Approach to Endometrial Cancer: Sentinel Lymph Node Evaluation Abstract 1. Introduction 2. Sentinel Lymph Node Detection 2.1. Tracer Injection Site 2.1.1. Uterine Corpus (Subserosal Myometrium) 2.1.2. Cervical Site 2.1.3. Endometrium 2.2. Lymphatic Mapping Method 2.2.1. Radio Nuclear Method 2.2.2. Colorimetric Methods 2.2.3. Near-Infrared Method 2.2.4. Combined Method 3. Anatomopathologic Alanalysis of SLNs 3.1. Clinical Implications of Low Volume Metastases 4. The Importance of Applying SLN Mapping Algorithm Conclusion References Chapter 8 Adjuvant Therapy for High-Risk Endometrial Cancer Abstract 1. Introduction 2. Low Risk Endometrial Cancer 2.1. Stage IA, Endometrioid G1-2 with LVSI Negative 3. Low-Intermediate Risk Endometrial Cancer 3.1. Stage IB, Endometrioid G1-2 with LVSI Negative 4. Intermediate-High Risk Endometrial Cancer 4.1. Stage IA Endometrioid G3 with LVSI Negative/Positive or Stage IA- IB Endometrioid G1-2 with LVSI Positive 4.1.1. Lymphadenectomy Performed with Negative Lymph Nodes 4.1.2. Lymphadenectomy Not Performed 5. High Risk Endometrial Cancer 5.1. Stage IB Endometrioid G3 with LVSI Positive/Negative, or Stage II-III, or Other Histologies at Any Stage 5.2. Stage I Endometrioid IB G3 with LVSI Positive/Negative 5.2.1. Lymphadenectomy Performed with Negative Lymph Nodes 5.2.2. Lymphadenectomy Not Performed 5.3. Stage II Endometrioid 5.3.1. Lymphadenectomy Performed with Negative Lymph Nodes 5.3.2. Lymphadenectomy Not Performed 5.4. Stage III Endometrioid 5.5. Other Histologies 5.5.1. Serous Carcinoma and Clear Cells 5.5.2. Carcinosarcomas and Undifferentiated Tumors 5.6. Molecular Classification References Chapter 9 Management of Advanced Endometrial Cancer Abstract 1. Introduction 2. Systemic Therapy 2.1. Hormonal Therapy 2.2. Chemotherapy 2.2.1. First Line Chemotherapy 2.2.2. Second Line Chemotherapy 2.2.3. Prognostic and Predictive Markers to Chemotherapy 2.3. New Biological Agents 3. Local Therapy 3.1. Surgery 3.2. Radiotherapy References Chapter 10 The Role of Radiotherapy Abstract 1. Introduction 2. The ESMO – ESGO – ESTRO Distribution of Risk Classes in Endometrial Cancer [1] 3. Role of Adjuvant Radiotherapy and Brachytherapy 3.1. ESMO – ESGO – ESTRO Consensus 3.1.1. Low Risk Endometrial Cancer (IA G1-G2, LVSI Negative) 3.1.2. Intermediate-Risk Endometrial Cancer (FIGO IB G1-G2, LVSI negative) High-Intermediate Risk Endometrial Cancer (IA G3 +/- LVSI; FIGO I G1-G2, LVSI Positive) 3.1.3. High Risk Endometrial Cancer (FIGO IB, Grade 3, Regardless of LVSI Status; Stage II- Stage III) 3.1.4. High Risk Non Endometrioid Cancers 3.2. NCCN Guidelines (Updated to 2018) 4. Role of Exclusive Radiation Therapy References Chapter 11 Endometrial Cancer in Elderly Patients Abstract 1. Introduction 2. Endometrial Cancer in the Elderly Patient 3. Geriatric Assessment Conclusion References Chapter 12 New Perspectives with Targeted Drugs Abstract 1. Introduction 2. PI3K/AKT/MTOR Inhibitors 3. EGFR and HER2 Inhibitors 4. Angiogenetic Inhibitors 5. Poly (ADP-Ribose) Polymerase Inhibitors 6. Immunotherapy Conclusion References Appendix I Conservative Treatments for Endometrial Cancer Abstract Introduction Conclusion References Appendix II Brachytherapy Technique in Endometrial Cancer Abstract Introduction Conclusion References Figures Tables Appendix III Role of Palliative Radiation Therapy in Endometrial Cancer Abstract Introduction References About the Editor Index Blank Page