Spezialfälle des Endometriumkarzinoms: Fertilitätserhalt und Prävention bei Hochrisikopatientinnen

Surgery is the therapy of choice for patients with endometrial carcinoma, including hysterectomy, bilateral salpingo-oophorectomy, assessment of peritoneal cytology and pelvic and para-aortic lymphadenectomy for patients with a risk of lymph metastases. Retention of the ovaries should be seriously considered for premenopausal women with endometrial carcinoma. For younger patients the standard therapy is operative treatment with hysterectomy and staging but a non-surgical treatment with hormone therapy can be applied for selected patients who wish to retain fertility. Because of the high risk of a simultaneous primary ovarian carcinoma in younger patients with endometrial cancer a thorough examination of the ovaries is necessary if they are to be retained. Most endometrial carcinomas occur sporadically but approximately 10% are genetically linked. There are 4 genetic models for the occurrence of EC: hereditary nonpolyposis colorectal carcinoma (HNPCC or Lynch II syndrome), Cowden syndrome (multiple hamartoma syndrome, PTEN hamartoma tumor syndrome), Peutz-Jeghers syndrome and an isolated predisposition for EC.