Stage IA and IB

• Surgery-total abdominal hysterectomy and bilateral salping-oophorectomy with omentectomy

Stage IC and Stage II

• Surgery followed by chemotherapy or radiation therapy. A clinical trial may be offered.

Stage III

• This stage may be subdivided into Optimally Cytoreduced Stage III Disease vs. Suboptimally Cytoreduced Stage III Disease The use of intraperitoneal (IP) chemotherapy is supported in those patients who have been optimally cytoreduced.
• Cytoreductive surgery followed by systemic or systemic/intraperitoneal chemotherapy. A clinical trial may be offered.

Stage IV

• Cytoreductive surgery followed by systemic chemotherapy. Consolidation and/or maintenance chemotherapy may be advised.
• Chemotherapy agents commonly utilized in the treatment of ovarian cancer include: cisplatin, carboplatin, paclitaxel, docetaxel, cyclophosphamide, topotecan, gemcitabine, and pegylated liposomal doxorubicin. The use of targeted drugs is under clinical evaluation primarily as consolidation therapy.

Uterine (Endometrial) Cancer

• Cancer of the endometrium is a highly curable tumor. To detect endometrial cancer, a technique that directly samples the endometrial tissue is mandatory. The Pap smear is not reliable as a screening procedure in endometrial cancer.
• Treatment selection is dependent on the degree of tumor differentiation as well as the stage of the disease.

Stage I and Stage IIA

• Surgery-total abdominal hysterectomy and bilateral salpingo-oophorectomy with removal of lymph nodes. If pelvic nodes are positive, then total pelvic radiation therapy may be given. If periaortic nodes are involved, then the patient is a candidate for clinical trials that could include radiation therapy and/or chemotherapy.

Stage IIB

Treatment could consist of one of the following options:

• TAH plus BSO and node sampling followed by postoperative radiation therapy
• Preoperative intracavitray and external beam radiation therapy followed by TAH and BSO plus node sampling
• Radical hysterectomy and pelvic lymphadenectomy in selected cases

Stage III

• Usual treatment is surgery and radiation therapy. If the patient is inoperable (tumor extends to the pelvic wall), treatment may be radiation therapy with combination of intracavitary and external-beam radiation therapy. Chemotherapy may be offered. The patient may be a candidate for a clinical trial.

Stage IV

• Treatment of patients with stage IV endometrial is dictated by the site of metastatic disease and symptoms related to disease sites. Treatment may consist of chemotherapy, radiation therapy and/or hormonal therapy.
• Radiation therapy could consist of a combination of intracavitary and external beam radiation therapy. Standard progestational hormonal agenst include hydroxyprogesterone (Delalutin), medroxyprogesterone (Provera), and megestrol (Megace). There is no standard chemotherapy program available for patients with metastatic uterine cancer. Agents that are commonly used include doxorubicin, paclitaxel and cisplatin.