Results

In the majority of cases, the disease presents as an endometrioid adenocarcinoma, clinically limited to the uterus.

Only one examination is necessary, a pelvic and abdominal MRI.
It provides a lot of information:
- confirmation that the tumor is limited to the uterine body
- depth of myometrial invasion
- appearance of important lymph node territories in endometrial cancer (pelvis, aortico-cellar)

Depending on the grade obtained by the endometrial biopsy and the depth of myometrial invasion given by the MRI, treatment will begin with:
- a non-conservative total hysterectomy with sentinel lymph node sampling
- or a non-conservative total hysterectomy with pelvic lymph node dissection and aortico-cellar
- these operations are most often performed by laparoscopy or robot-assisted laparoscopy. More rarely, a laparotomy (classic opening of the abdomen) may be used, due to certain parameters (size of the uterus, associated medical pathologies, abdominal adhesions, etc.).

In the rarer cases where a serous cancer is diagnosed, or in the event of clinical abdominal extension or on the MRI for example, a thoraco-abdomino-pelvic scanner and a CA 125 marker assay will also be used.
We are thus looking for (or taking stock of) an associated abdominal extension.
The treatment will then be different, starting with an intervention (non-conservative total hysterectomy, omentectomy (removal of the omentum, fatty apron hanging from the stomach and the transverse colon), pelvic and aortico-caval dissections, appendectomy, etc. ). These operations are of the same type as those performed for ovarian cancer (see specific tab).
Treatment may also begin with chemotherapy, possibly followed by surgery.

We understand the importance of the initial assessment. It is necessary to know from the beginning the precise histological characteristics of the tumor and its clinical and imaging extension.
It is also important to know the general state and the associated pathologies (co-morbidity) because they can modify the management by preferring chemotherapy to a major intervention with a significant perioperative risk.

Hysterectomy
It is the removal of the uterus. In the case of endometrial cancer, it is called total (because it removes the cervix) and non-conservative (because it removes the ovaries and fallopian tubes).
It allows the removal of the tumor (which is inside the uterus) with a margin of safety compared to the remaining tissues.
She must respect the rules of oncological surgery: no uterine manipulator during the procedure, no morcellation of the uterus, etc.

Laparoscopy
The procedure is performed with small instruments (5mm in general) passed through trocars above the pubis. The surgeon sees inside the belly thanks to an optic coupled to a camera.
These procedures must be performed under general anesthesia and require the belly to be “inflated” with CO2 to move the intestine away from the uterus.
Procedures performed by laparoscopy last longer than procedures performed by laparotomy, but are associated with fewer complications during and after the procedure. The duration of hospitalization and convalescence are also shorter after laparoscopy. Finally, survival is comparable after laparoscopy or laparotomy. These data were validated by randomized clinical trials in the 1990s and early 2000s.

Robot-assisted laparoscopy
It is actually an improved laparoscopy. The operator is seated at a console which provides him with a High Definition 3-dimensional view. The instruments are not held directly by the surgeon's hand, but manipulated using ultra-precise controls. The robot improves the precision and quality of complex procedures, especially in obese patients.

Sentinel node
The removal of lymph nodes is part of the surgical and anatomopathological assessment of most cancers. This makes it possible to estimate the prognosis and decide on treatments. Until recently, this lymph node removal was done by a dissection that removed a large number of lymph nodes.

The sentinel lymph node technique involves removing only the first lymph node(s) that drain a tumor.

This technique has the advantage of being less aggressive surgically, with in particular fewer complications (bleeding during the procedure, nerve or urinary wounds, large leg: lymphedema; pockets of lymph: lymphocele).
It allows equal