Garg on Treatment Paradigms for Patients With Endometrial Cancer

Ruchi Garg, MD, chair of gynecologic oncology at City of Hope Atlanta, Chicago, and Phoenix, discusses current treatment options and strategies being utilized for patients with endometrial cancer.

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0:08 | Most commonly, most patients will initially present with postmenopausal bleeding. That's seen in about 70% to 80% of the patients. With that, a whole workup has to be ensued, including most commonly an endometrial biopsy in the patient who one has a high suspicion of cancer for. Even if they don't, for anyone who has postmenopausal bleeding, the gold standard is to get a biopsy. Once a biopsy is done it, it determines if there is endometrial cancer, the factors that we look at, or whether what's the grade of the cancer, and what's the histology, the subtype, the cellular type of the cancer, and that determines if there is further imaging that's needed. For example, high-grade cancers, my routine practice is to actually perform a CAT scan to make sure there's no metastatic disease prior to going for a surgical option. But in lower grade cancers, we can just sort of do a full exam and make sure there is no concern for metastatic disease prior to proceeding with surgical management.

1:25 | With the surgical options, the most commonly adopted or most common method that we utilize is our robotic, laparoscopic minimally invasive surgery approach, where we end up doing a hysterectomy with the removal of tubes and ovaries. That's the most common method along with doing the dissection where we can talk about the sort of variety of lymph node dissection. The newest protocol is doing something called sentinel lymph nodes, rather than doing the full lymph node dissection.

2:04 | In more advanced or more high-risk endometrial cancers, there is a role for doing omentectomy, which is the fatty apron that sits inside the abdomen and that can be exposed to these cancer cells as well. Subsequently, we determine based on the pathology, whether the patient can go on observation, if they qualify, or whether they need some adjuvant therapy to decrease their risk of the recurrence of cancer.