Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:


Accurate diagnosis of early stage uterine cancer requires lymph-node check


Research at Washington University School of Medicine in St. Louis suggests that the accurate diagnosis of early stage endometrial cancer requires that the abdominal lymph nodes always be removed and checked for signs of cancer. The recommendation extends even to women with tumors that seem to have the smallest risk of spread. The study will be presented June 2 at the American Society of Clinical Oncology (ASCO) meeting in Chicago, Ill.

The study indicates that by examining the lymph nodes in all women with this disease, doctors can save patients from unnecessary radiation therapy, give the appropriate level of therapy to those who need it and save millions of dollars nationally.

"These findings are important," says Washington University lead investigator Thomas J. Herzog, M.D., associate professor of obstetrics and gynecology and a cancer specialist at the Siteman Cancer Center and Barnes-Jewish Hospital. "If confirmed, they will have direct clinical application and may change how many surgeons treat endometrial cancer."

Accurately determining how far cancer has progressed, a process known as staging, is essential for determining the most effective treatment for cancer patients. A tumor that has spread, or metastasized, to the lymph nodes requires stronger treatment than one that is still confined to the uterus.

"The problem is that many physicians believe early stage endometrial cancer is readily curable just by removing the uterus," says co-author Matthew A. Powell, M.D., instructor in the Division of Gynecologic Oncology. "They feel it is unnecessary to refer women to a surgical oncologist for removal and examination of the nodes."

Presently, fewer than half of women with stage 1 endometrial cancer have lymph nodes removed and checked for malignant cells. Instead, many doctors stage endometrial cancer by looking only at the tumor’s microscopic appearance and how far it has penetrated the uterine wall.

Endometrial cancer is the most common gynecological cancer in the United States, with doctors diagnosing about 40,000 cases annually. About 6,800 women die of the disease each year. About half of the women diagnosed have grade 1 endometrial cancer. The overall survival for these women is more than 90 percent.

Powell notes, however, that in 3 to 5 percent of women with grade 1 disease, the cancer has spread to the lymph nodes. Once that happens, the survival rate falls to about 60 percent.

Staging of endometrial cancer is done during surgery. Currently, an early stage tumor is treated by removal of the uterus, a procedure known as a hysterectomy. If the tumor has not spread, hysterectomy alone will usually cure the cancer. If the tumor has spread to the lymph nodes, additional therapy is needed. If the spread is minor, doctors often treat the vagina with localized radiation therapy. If the spread is broader, an external beam of radiation is used.

Often, patients are treated with radiation following surgery without checking the lymph nodes to see if the cancer has spread.

"Our findings show that if we check the lymph nodes and find no sign of cancer, we don’t need to give radiation," says Powell.

The retrospective study conducted by Herzog, Powell and colleagues looked at 144 women diagnosed with grade 1, apparent stage 1 endometrial cancer. Lymph node removal was done in 102 of these patients. The researchers looked at the records of the 102 women and determined what treatment they would have received based only on the characteristics of the tumor, as if the lymph-node examine had not been done.

They found that additional radiation therapy would have been recommended for 40 of the patients. The lymph-node exam, however, showed that only 18 of those patients actually required radiation, thereby preventing unneeded treatment in 22 patients. Another five patients would have received radiation therapy that would have been more intense than necessary. The lymph node exam also identified three women with disease that was more advanced than would have been suspected.

A cost analysis done by the researchers estimated that avoiding the unnecessary use of radiation therapy for early stage endometrial cancer could save $28 million annually in the United States.

"Based on these findings we concluded that all women with endometrial cancer, even those with minimum risk factors, should have lymph nodes examined to spare patients unnecessary treatment and reduce the cost of care," Herzog says.

Horowitz NS, Powell MA, Smith JH, Rader JS, Gibb RK, Mutch DG, Brouwer ES, Herzog TH. Staging grade 1 endometrial cancer: saving dollars and lives. American Society of Clinical Oncology annual meeting, Abstract number 1835, June 2, 2003.

The full-time and volunteer faculty of Washington University School of Medicine are the physicians and surgeons of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient-care institutions in the nation. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.

Darrell E. Ward | EurekAlert!
Further information:

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Space observation with radar to secure Germany's space infrastructure

Satellites in near-Earth orbit are at risk due to the steady increase in space debris. But their mission in the areas of telecommunications, navigation or weather forecasts is essential for society. Fraunhofer FHR therefore develops radar-based systems which allow the detection, tracking and cataloging of even the smallest particles of debris. Satellite operators who have access to our data are in a better position to plan evasive maneuvers and prevent destructive collisions. From April, 25-29 2018, Fraunhofer FHR and its partners will exhibit the complementary radar systems TIRA and GESTRA as well as the latest radar techniques for space observation across three stands at the ILA Berlin.

The "traffic situation" in space is very tense: the Earth is currently being orbited not only by countless satellites but also by a large volume of space...

Im Focus: Researchers Discover New Anti-Cancer Protein

An international team of researchers has discovered a new anti-cancer protein. The protein, called LHPP, prevents the uncontrolled proliferation of cancer cells in the liver. The researchers led by Prof. Michael N. Hall from the Biozentrum, University of Basel, report in “Nature” that LHPP can also serve as a biomarker for the diagnosis and prognosis of liver cancer.

The incidence of liver cancer, also known as hepatocellular carcinoma, is steadily increasing. In the last twenty years, the number of cases has almost doubled...

Im Focus: Researchers at Fraunhofer monitor re-entry of Chinese space station Tiangong-1

In just a few weeks from now, the Chinese space station Tiangong-1 will re-enter the Earth's atmosphere where it will to a large extent burn up. It is possible that some debris will reach the Earth's surface. Tiangong-1 is orbiting the Earth uncontrolled at a speed of approx. 29,000 km/h.Currently the prognosis relating to the time of impact currently lies within a window of several days. The scientists at Fraunhofer FHR have already been monitoring Tiangong-1 for a number of weeks with their TIRA system, one of the most powerful space observation radars in the world, with a view to supporting the German Space Situational Awareness Center and the ESA with their re-entry forecasts.

Following the loss of radio contact with Tiangong-1 in 2016 and due to the low orbital height, it is now inevitable that the Chinese space station will...

Im Focus: Alliance „OLED Licht Forum“ – Key partner for OLED lighting solutions

Fraunhofer Institute for Organic Electronics, Electron Beam and Plasma Technology FEP, provider of research and development services for OLED lighting solutions, announces the founding of the “OLED Licht Forum” and presents latest OLED design and lighting solutions during light+building, from March 18th – 23rd, 2018 in Frankfurt a.M./Germany, at booth no. F91 in Hall 4.0.

They are united in their passion for OLED (organic light emitting diodes) lighting with all of its unique facets and application possibilities. Thus experts in...

Im Focus: Mars' oceans formed early, possibly aided by massive volcanic eruptions

Oceans formed before Tharsis and evolved together, shaping climate history of Mars

A new scenario seeking to explain how Mars' putative oceans came and went over the last 4 billion years implies that the oceans formed several hundred million...

All Focus news of the innovation-report >>>



Industry & Economy
Event News

New solar solutions for sustainable buildings and cities

23.03.2018 | Event News

Virtual reality conference comes to Reutlingen

19.03.2018 | Event News

Ultrafast Wireless and Chip Design at the DATE Conference in Dresden

16.03.2018 | Event News

Latest News

For graphite pellets, just add elbow grease

23.03.2018 | Materials Sciences

Unique communication strategy discovered in stem cell pathway controlling plant growth

23.03.2018 | Agricultural and Forestry Science

Sharpening the X-ray view of the nanocosm

23.03.2018 | Physics and Astronomy

Science & Research
Overview of more VideoLinks >>>