Endometrial cancer metastasis pathways and treatment

What are the metastatic pathways and treatments for endometrial cancer? Many people are very concerned about these issues. Endometrial cancer grows slowly and is confined to the endometrium for a long time, but a few develop rapidly. The main metastatic pathways are direct spread, lymphatic metastasis, and blood metastasis in the late stage.

1. Direct spread

At the beginning, the cancer spreads along the endometrium, upward through the uterine horn to the fallopian tube, downward to the cervical canal, and continues to spread to the vagina. It can also infiltrate through the muscle layer to the uterine serosa and extend to the fallopian tube and ovary. It can also be widely implanted in the pelvic peritoneum, rectouterine pouch and greater omentum.

2. Lymphatic metastasis

It is the main metastatic pathway of endometrial cancer. When the tumor infiltrates into the deep muscle layer, or spreads to the cervical canal, or the cancer tissue is poorly differentiated, lymphatic metastasis is likely to occur. Its metastatic pathway is related to the location of the cancer growth. The cancer lesions at the fundus of the uterus spread along the lymphatic network of the upper part of the broad ligament, through the pelvic infundibulocytic ligament to the ovaries. Upward to the para-aortic lymph nodes. The cancer lesions in the uterine cornu extend along the round ligament to the inguinal lymph nodes. The cancer lesions in the lower uterine segment and cervical canal have the same lymphatic metastasis pathway as cervical cancer, and can spread to the paracervical, internal iliac, external iliac, and common iliac lymph nodes. The cancer lesions on the posterior wall of the uterus can spread along the uterosacral ligament to the rectal lymph nodes. Endometrial cancer can also spread to the front of the uterus to the bladder, and drain to the anterior wall of the vagina through retrograde drainage.

3. Hematogenous metastasis

Less common. In the late stage, it metastasizes to the lungs, liver, bones, etc. through the blood.

treat

1. Surgery is the first choice. Patients in stage I should undergo extrafascial total hysterectomy and bilateral adnexectomy, and patients in stage II should undergo extensive total hysterectomy and pelvic lymph node dissection.

2. Combined surgery and radiation therapy: For patients in stage I, if cancer cells are found in the ascites or the myometrium is infiltrated, and there is lymph node metastasis, external irradiation is given after surgery. For patients in stage II or some stage III, external irradiation or intracavitary irradiation is given before surgery, and surgery is performed 1 to 2 weeks after the end of radiotherapy.

3. Radiotherapy: The elderly, frail patients, patients with severe medical complications who cannot tolerate surgery, and patients in stage III or above who are not suitable for surgery can be treated with radiotherapy, including intracavitary and external irradiation.

4. Hormone therapy Young patients in the early stage who want to retain their fertility, patients with advanced cancer who cannot undergo surgery or with cancer recurrence can be treated with large doses of synthetic progesterone, such as 400 mg of medroxyprogesterone acetate, intramuscular injection, 2 to 3 times a week; 500 mg of progesterone acetate, intramuscular injection, 2 to 3 times a week, etc. The efficacy can be evaluated after at least 12 weeks.

5. The anti-estrogen drug tamoxifen has the same indications as progestin therapy. The general dose is 20-40 mg/d, taken orally. It can be used for a long time or in divided courses.

6. For advanced cases that cannot undergo surgery or radiotherapy, or those that relapse after treatment, anti-cancer chemotherapy can be combined with chemotherapy such as 5-fluorouracil (5-Fu), cyclophosphamide (CTX), mitomycin (MMC), doxorubicin (BDR), and cisplatin (DDP), which has a certain effect.

Women should choose the most suitable one according to the doctor's advice in their life. Everyone is afraid of suffering from endometrial cancer, but due to the lack of certain understanding of endometrial cancer, you must not procrastinate, otherwise it will get worse over time.