Certain features of an endometrial adenocarcinoma can help to predict potential routes of recurrence. Identification of high risk sites for recurrence can help guide adjuvant therapy and monitoring.
Parameters:
(1) percent of myometrial invasion
(2) clinical stage
(3) histologic type
(4) histologic grade
(5) cervical stromal invasion
(6) number of lymph node metastases
(7) peritoneal cytology
(8) lymphovascular invasion
Findings
Route of Recurrence
Stage I, negative lymph nodes, myometrial invasion >= 66%
hematogenous
Stage II to IV, myometrial invasion > 50%
hematogenous
Stage II or III with >= 2 risk factors (see below)
peritoneal
Stage IV disease
peritoneal
lymph node metastases
lymphatic
cervical stromal invasion
lymphatic
Grade 3 histology (poorly differentiated)
vaginal
lymphovascular invasion
vaginal
where:
• Risk factors for peritoneal spread in Stage II or III disease: positive peritoneal cytology, lymph node metastases, nonendometrioid histology, cervical stromal invasion
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