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Erschienen in: Die Gynäkologie 3/2022

08.03.2022 | Endometriumkarzinom | CME

Aktuelle Diagnostik und Therapie des Endometriumkarzinoms

verfasst von: Dr. med. Davut Dayan, Prof. Dr. Wolfgang Janni, Kerstin Pfister

Erschienen in: Die Gynäkologie | Ausgabe 3/2022

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Zusammenfassung

Das Endometriumkarzinom („endometrial carcinoma“, EC) ist die vierthäufigste Krebserkrankung der Frau in Deutschland. Mit Zunahme der Risikofaktoren (allen voran Adipositas) nimmt die Inzidenz zu. Aufgrund der Initialsymptome der Blutungsstörung in der Prämenopause bzw. postmenopausale Blutung wird das EC überwiegend im Frühstadium durch Hysteroskopie mit fraktionierter Abrasio diagnostiziert. Pathologisch lässt sich das EC in Typ‑I (östrogenabhängiges endometrioides Adenokarzinom mit guter Prognose) und Typ-II (östrogenunabhängiges seröses, klarzelliges Karzinom mit schlechterer Prognose) unterteilen. Die minimal-invasive Behandlung mittels laparoskopischer totaler Hysterektomie mit Adnexektomie beidseits stellt den Goldstandard der Behandlung des frühen endometrioiden Adenokarzinoms dar. Im fortgeschrittenen Stadium, hingegen, sowie bei Typ-II-Karzinomen sind zusätzlich eine paraaortale und pelvine Lymphonodektomie bzw. eine Omentektomie notwendig. Neue wissenschaftliche Errungenschaften zu molekularbiologischen Typisierungen des EC stellen uns vor Herausforderungen in der routinemäßigen Patientinnenversorgung. Während POLE(„polymerase epsilon“)-mutierte Tumoren eine sehr gute Prognose haben, zeigen die MSI(„microsatellite instability“)-„hypermutated“ und „copy number low“ (auch „no specific molecular risk profile“, NSMP) Tumoren eine intermediäre Prognose, die „copy number high“ (auch TP53[„tumor protein 53“]-mutiert) die schlechteste. L1CAM(„L1 neuronal cell adhesion molecule“)-Positivität ist ein weiterer ungünstiger Prognosefaktor.
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Metadaten
Titel
Aktuelle Diagnostik und Therapie des Endometriumkarzinoms
verfasst von
Dr. med. Davut Dayan
Prof. Dr. Wolfgang Janni
Kerstin Pfister
Publikationsdatum
08.03.2022
Verlag
Springer Medizin
Erschienen in
Die Gynäkologie / Ausgabe 3/2022
Print ISSN: 2731-7102
Elektronische ISSN: 2731-7110
DOI
https://doi.org/10.1007/s00129-022-04909-6

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