Endometrial Cancer

Abstract

This tumor has a progressive locoregional spread, with a relatively low incidence of distant metastases. Four dissemination ways are known (direct extension to adjacent structures; transtubal, lymphatic, and hematogenous). Currently, there are two systems for staging endometrial cancer (the FIGO system, which is the most commonly used, and the AJCC TNM staging system). The technique of choice for staging is magnetic resonance imaging, since it assists in preoperative assessment and surgical planning by helping predict the depth of myometrial invasion, cervical involvement, distant spread, and lymph node involvement. The lymphatic drainage is complex and follows a less orderly pattern than other tumors. Moreover, the pathway differs depending on the site of the primary cancer being, the pelvic pathway the most common route of lymphatic spread. Pelvic lymph node dissection with or without para-aortic dissection is recommended, but sentinel lymph node mapping can be considered due to the high sensitivity provided by ultrastaging. It has been widely studied in low-risk endometrial cancers and its application in intermediate and high-risk patients is being investigated, although it is feasible. Despite other tumors, different ways of injection have been reported. The most used tracers are radiotracers and fluorescent tracers. The information provided by SPECT/CT increases the number of SLNs identified and the number of lymphatic chains with drainage. Other imaging alternatives like PET/CT or surgical approaches like radioguided occult lesion localization can be used depending on the case.