The role of robotic assisted treatments for endometrial cancer

 Endometrial Cancer means cancer of the uterine lining. It can be of various histological types mainly divided into two categories

-          Low Risk – Endometrial Aenocarcinoma

-          High Risk – Serious Carcinoma, clear all carcinoma etc

Besides these, there are some tumors arising from other layers of the uterus like carcinosarcoma, Endometrial stromal sarcoma, Leiomyosarcoma etc.

Epidemiology/ Causes

Incidence in India is increasing due to lifestyle changes associated with higher incidence of obesity and Type II diabetes. About 20% can be hereditary and can also be associated with lynch syndrome.

Symptoms

-          Perimenopausal and Postmenopausal bleeding per vagina

-          Irregular Heavy periods

-          Inter-menstrual bleeding

-          Pelvic pain – in case of advanced disease.

Clinical Examination

When a patient comes to a gynecologist with such symptoms, after proper history is taken (anal) per speculum examination is done to see the cervix and Pap smear is taken, Per vaginal examination is done which might reveal a bulky uterus.

Endometrial Bx is obtained using pipelle and is sent for histopathology examination.

Radiological Investigation and Blood Tests

-          MRI pelvis and screening of upper abdomen is done which gives information about the size of tumor, site of tumor and depth of the myometrial invasion, along presence of pelvis/paraaortic lymph nodes.

-          Presence of ascites, omental disease indicates advanced disease

-          Bil mammography must be done.

-          X-Ray of the chest and CT Thorax

Treatment of Endometrial Cancer

-          The stage of the Endometrial cancer is the most important factor in choosing the treatment

-          Other important factors are comorbidities like gross obesity, diabetes, hypertension etc.

-          In young patients with early cancer, conservative treatment (high dose progesterone have to be given) can be done followed by pregnancy which may require IVF, followed by surgery postpartum.

Methods of surgery

Exploratory laparotomy, Panhysterectomy, either sentinel node biopsy in the hands of experts or complete pelvic para-aortic node dissection was the standard of care. In high-risk cases, omentectomy and stapling cytology has to be added. The standard of care now is minimally invasive surgery either laparoscopic or robotic.

Laparoscopic surgery must be only by experts who are also onco surgeons, so that there is no oncological compromise and results in terms of survival must remain comparatively good.

The advancement in medicine and science, tend to reveal that with new research comes novel breakthrough. In recent times, robotic- assisted surgery has taken medical care to great heights and better treatment outcomes, and this marked a paradigm shift in management of endometrial cancer. Robotic-aided surgery has been established as the gold standard treatment for gynecological cancer.

 

Dr. Kalpana Kothari, Senior Consultant, Robotic Surgeon and Chief of Gynaec Oncology department, HCG Cancer Centre Ahmedabad