Endometrial cancer

Team members: Tropé, Kristensen, Danielsen, Abeler, Risberg, Manohar

Ongoing clinical studies:

1. Molecular biological and dynamic MR as preoperative account to find optimal treatment of patients with early endometrial cancer

2. Fertility saving treatment at endometrial cancer
Endometrial hyperplasia with atypia is considered a initial stage to endometrial cancer. Endometrial hyperplasia with atypia is an unusual finding with young women in fertile age. Depending on the degree og atypia this age group can be treated with progesterone, either systematic or locally for up to three months if there is a desire to maintain fertility. As these women often have fertility problems due to hormonal causes, ovulation treatment may be considered, and if necessary assisted fertilisation. In the literature there are a few reported cases where women with highly differentiated endometrial cancer stadium I and wishing to preserve fertility has been conservatively treated with hysteriscopical resection of the endometrium and/or endometrial polyp, followed by eight weeks of progesterone treatment. About 20 healthy children in the world has been born after completing such a treatment. It should be stressed that it is only women in fertile age and with low risk cancer who may be given this treatment. Evaluation and treatment must only take place at a clinic having satisfactory competence in the field.

3. Laparoscopic surgery at endometrial carcinoma
The first laparoscopical hysterectomy was in 1988 carried out in a patient by dr. Reich. Langbrekke and coworkers performed laparoscopical hysterectomy as the first in the Nordic region in 1991. Five years later they published prospective randomised studies of 100 patients. After 1988, when FIGO recommended that endometrial carcinomas should be divided into surgical stages. Childers and coworkers showed it was OK to remove pelvical and paraaortical lymph nodes by laparoscopical assisted vaginal hysterectomy. This was a breakthrough for laparoscopical surgery at endometrial carcinoma, and attracted a lot of attention. It is of utmost importance that only centres that have combined endoscopical and oncological experise should perform this surgical technique. Still there are not yet any published prospective randomised studies that compare laparoscopic to conventional surgery. Such studies are difficult to perform, of several reasons. The type of laparoscopic surgery that has been most used by endometrial cancer is laparoscopical assisted vaginal hysterctomy. The progress, even in this field, has been rapid, and now total laparoscopical hysterectomy is today the standard intervention, without combining the treatment with vaginal surgery.

Translational research

1. Image cytometric dna ploidy analysis of endometrial carcinoma (Pradhan)
Mål:
- Vurdere reproduserbarhet ved DNA ploidi undersøkelser .
- Gir DNA ploidi analyse av curettage materiale samme resultater som analyse av hysterektomi preparater ved endometriekarsinom
- Studere korrelasjon mellom subtyping/gradering av endometriekarsinom og DNA ploidi funn.
- Prognostisk signifikans av DNA ploidi funn ved endometriekarsinom.
- Relasjon mellom molekylære markører, DNA ploidi og prognose.