Aktuelle Aspekte zur Diagnostik und Therapie des Endometriumkarzinoms

Zusammenfassung

Das Endometriumkarzinom ist das häufigste Karzinom des weiblichen Genitales. Führendes klinisches Zeichen ist die postmenopausale Blutung. Für die Diagnosestellung ist immer eine Endometriumbiopsie notwendig. Die Therapieentscheidung hängt von der Risikoeinschätzung des Karzinoms und der häufig vorliegenden Komorbidität ab. In Fällen mit niedrigem Risiko (Definition: pT1 a, G1/2) ist eine pelvine und paraaortale Lymphknotendissketion unnötig. Eine adjuvante Bestrahlung und eine Systemtherapie sind zumeist vermeidbar. Die Behandlung von Hochrisikopatientinnen (G3 und/oder pT1b) und von Patientinnen in palliativer Situation ist schwierig und weniger gut standardisiert. Neue, molekular definierte Subtypen könnten hier zukünftig Therapieentscheidungen erleichtern.

Abstract

Endometrial carcinoma is the most common carcinoma of the female genital tract. Its most important clinical sign is postmenopausal bleeding. An endometrial biopsy is essential for diagnosis. Treatment decisions are governed by tumour risk assessment and patient comorbidity, which is often present. Pelvic and paraaortic lymph node dissection is unnecessary in low risk cases (definition: pT1 a, G1/2) and adjuvant radiotherapy and systemic treatments are usually avoidable. Treatment of high-risk patients (G3 and/or pT1b) and palliative cases is difficult and not well standardised. New molecular-based subtype classification may help treatment decision making in future.

Schlüsselwörter

Endometriumkarzinom - paraaortale Lymphknotendissektion - Endometriumdicke - Ultraschall - postmenopausale Blutung

Key words

endometrial carcinoma - paraaortic lymph node dissection - endometrial thickness - ultrasound - postmenopausal bleeding

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