1. surgical therapy
It is the first choice for treatment. The first purpose of the operation is to stage the operation and pathology, and determine the scope of the lesion and the important factors related to the prognosis; The second is to remove the cancerous uterus and other possible metastatic lesions. First, conduct a comprehensive exploration during the operation, and take samples from suspected lesions for frozen section examination. And leave ascites or peritoneal lavage fluid for cytological examination. The excised uterine specimens were sliced to determine whether there was myometrial infiltration. Pathological examination should be performed routinely on surgical specimens, and estrogen and progesterone receptors should be detected in cancer tissues as the basis for choosing adjuvant treatment after operation. Stage I patients should undergo extrafascial hysterectomy and bilateral appendectomy. In any of the following circumstances, pelvic and paraaortic lymph nodes should be cleaned or sampled; Special pathological types such as papillary serous adenocarcinoma, clear cell carcinoma, squamous cell carcinoma, undifferentiated carcinoma, etc. Endometrioid adenocarcinoma G3; Depth of myometrial infiltration; Cancer involves more than 50% of the uterine cavity or isthmus. In view of the high malignant degree of endometrial papillary serous carcinoma, which has lymph metastasis and pelvic and abdominal metastasis in the early stage, its clinical stage I operation scope should be the same as that of ovarian cancer. Besides exploring and removing uterus and double appendages to clean retroperitoneal lymph nodes, omentum and appendix should also be removed. In the second stage, total hysterectomy or extensive hysterectomy and double appendectomy were performed, and pelvic and paraaortic lymph nodes were also removed. The operation scope of patients with advanced stage ⅲ and ⅳ is the same as that of ovarian cancer, and tumor cell reduction should be performed.
2. Radiotherapy
It is the most important postoperative adjuvant therapy for endometrial cancer, which can significantly reduce local recurrence and improve the survival rate. Patients with deep myometrial infiltration, lymph node metastasis, pelvic and vaginal residual lesions should be treated with radiotherapy after operation.
3. Progesterone therapy
It is mainly used for the treatment of advanced or recurrent endometrial cancer.
4. Antiestrogen therapy
Indications are the same as progesterone.
5. Chemotherapy
It is one of the comprehensive treatment measures for advanced or recurrent endometrial cancer. It can also be used to treat patients with high risk factors of postoperative recurrence, so as to reduce distant metastasis outside the pelvic cavity. Commonly used chemotherapy drugs are cisplatin, adriamycin, paclitaxel, cyclophosphamide, fluorouracil, mitomycin, etoposide and so on. Can be used alone or in combination, and can also be used in combination with progesterone. The uterine papillary serous adenocarcinoma should be given postoperative chemotherapy, and the scheme is the same as that of ovarian epithelial carcinoma.