Nodal palpation 'essentially worthless: Endometrial Ca Tx may call for specialist referral. (Gynecology).

VAIL, COLO. -- Endometrial cancer therapy has become so sophisticated that this malignancy, like other gynecologic cancers, is now best managed by gynecologic oncologists rather than gynecologists, Dr. Susan A. Davidson asserted at a conference on obstetrics and gynecology sponsored by the University of Colorado.

For example, there is broad agreement among gynecologic oncologists that palpation is "essentially worthless" as a technique for assessing the lymph nodes in endometrial cancer patients. Studies have shown that less than 30% of positive lymph nodes are detected by palpation. And nearly half of positive nodes are normal in size--that is, less than 1 cm, said Dr. Davidson, chief of the division of gynecologic oncology at the university.

There is a widespread myth that stage I, grade 1 endometrial cancer is a low-risk malignancy In reality, 10% of these cancers prove to be deeply invasive, and there is a substantial upgrade rate upon final pathologic examination, she continued.

The practice trend among gynecologic oncologists is increasingly to do an extensive lymph node dissection. Node-negative stage I patients can then be treated with vaginal brachytherapy, since the vaginal cuff is the one place in the pelvis where such patients are at risk for recurrence. Brachytherapy entails three to five outpatient visits, compared with the far more intensive 5- to 6-week whole-pelvis radiotherapy regimens. Moreover, the cost of brachytherapy is roughly half that of whole-pelvis radiation therapy, and there are far fewer complications.

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