Management of Grade 2 Endometrial Adenocarcinoma

Initial Surgical Management

The European Society for Medical Oncology recommends total hysterectomy with bilateral salpingo-oophorectomy as the cornerstone of treatment for endometrial cancer, which should include peritoneal fluid sampling and thorough exploration of the abdominal cavity and lymph nodes 1, 2
Peritoneal fluid or washings should be obtained for cytology, as recommended by the European Society for Medical Oncology 1, 2
Thorough exploration of the abdominal cavity and pelvic and para-aortic nodal areas should be performed, according to the European Society for Medical Oncology 1, 2
Pelvic lymphadenectomy is recommended for complete surgical staging by the British Journal of Cancer 3, 4
Para-aortic lymph node assessment should be considered, particularly if pelvic nodes appear suspicious, as suggested by the British Journal of Cancer 3, 4

For low-risk Stage IA/IB, grade 2, endometrioid histology, follow-up alone is standard for Stage IA grade 2 tumors, as recommended by the European Society for Medical Oncology and the British Journal of Cancer 1, 4
For Stage IB grade 2 tumors, options include vaginal brachytherapy or follow-up alone, according to the British Journal of Cancer 4
Adjuvant pelvic radiotherapy significantly reduces the risk of pelvic/vaginal relapses but has no impact on overall survival, as reported by the European Society for Medical Oncology 1

For Stage IIA (endocervical glandular involvement only), postoperative vaginal brachytherapy is standard if myometrial invasion is less than 50%, as recommended by the British Journal of Cancer 4
For Stage IIB (cervical stromal invasion), postoperative external pelvic radiotherapy with brachytherapy boost is standard, according to the British Journal of Cancer 4

For Stage IIIA (tumor invades serosa/adnexa or positive peritoneal cytology), options include postoperative pelvic radiotherapy or abdomino-pelvic radiotherapy, as suggested by the British Journal of Cancer 4, 5
For Stage IIIB (vaginal involvement), pelvic external beam irradiation with brachytherapy is standard, according to the British Journal of Cancer 4, 5
For Stage IIIC (lymph node metastasis), postoperative pelvic radiotherapy with brachytherapy boost is recommended for pelvic nodes, as reported by the British Journal of Cancer 4, 5

Debulking surgery including total hysterectomy with bilateral salpingo-oophorectomy is recommended for Stage IVA/IVB, as suggested by the British Journal of Cancer 4
Postoperative external radiotherapy with or without brachytherapy is recommended for Stage IVA/IVB, according to the British Journal of Cancer 4

Combination of cisplatin and doxorubicin has shown significant improvement in progression-free and overall survival for optimally debulked stage III and IV disease compared to radiation therapy alone, as reported by the European Society for Medical Oncology 1
Carboplatin plus paclitaxel represents an efficacious, lower-toxicity alternative regimen, according to the European Society for Medical Oncology 1