Endometrium Kanserinde Güncel Tanı ve Tedavi
Özet
Endometrium kanseri (EK), kadınlarda en sık görülen genital kanser olup vakaların büyük kısmı perimenopozal dönemde, erken evrede teşhis edilmektedir. Obezite, karşılanmamış östrojen ve genetik yatkınlık en önemli risk faktörleridir. Hastalık, östrojen bağımlı iyi prognozlu Tip 1 ve hormon reseptör negatif kötü prognozlu Tip 2 olmak üzere iki histolojik gruba ayrılır. Tanıda altın standart endometrial biyopsidir. FIGO sınıflamasına göre evrelendirilen hastalıkta preoperatif değerlendirme için MRG en doğru görüntüleme yöntemidir. 2013 TCGA çalışmasıyla EK; POLE, MSI, kopya sayısı düşük ve kopya sayısı yüksek (p53 mutasyonlu) olarak 4 moleküler alt gruba ayrılmış; ProMisE algoritmasıyla klinik uygulamaya aktarılmıştır. Ana tedavi histerektomi ve bilateral salpingoooferektomi ile cerrahi evrelemedir. NCCN kılavuzuna göre primer ve adjuvan tedaviler (radyoterapi, kemoterapi, brakiterapi) evre ile risk faktörlerine göre planlanır. Son yıllarda immünoterapi (Pembrolizumab) ve hedefe yönelik ajanlar (Bevacizumab, Trastuzumab) ön plana çıkmıştır. Erken evre ve uygun genç hastalarda fertilite koruyucu hormonal yaklaşım denenebilir. Radikal tedavi sonrasında hastalar ilk 2 yıl 3-4 ayda bir, ardından 5 yıla kadar 6 ayda bir izlenir.
Endometrial cancer (EC) is the most common genital cancer in women, with most cases diagnosed at an early stage during the perimenopausal period. Obesity, unopposed estrogen, and genetic predisposition are the primary risk factors. The disease is divided into two histological groups: estrogen-dependent, good-prognosis Type 1 and hormone receptor-negative, poor-prognosis Type 2. Endometrial biopsy remains the gold standard for diagnosis. Staged according to FIGO classification, MRI is accepted as the most accurate imaging modality for preoperative assessment. Following the 2013 TCGA study, EC was categorized into four molecular subgroups (POLE, MSI, copy-number low, and copy-number high/p53-mutated), which were translated into clinical practice via the ProMisE algorithm. The primary treatment consists of hysterectomy, bilateral salpingo-oophorectomy, and surgical staging. According to NCCN guidelines, primary and adjuvant therapies (radiotherapy, chemotherapy, brachytherapy) are tailored based on stages and risk factors. Recently, immunotherapy (Pembrolizumab) and targeted agents (Bevacizumab, Trastuzumab) have gained prominence. Conservative hormonal approaches can be considered for fertility preservation in eligible young patients with early-stage disease. Following radical treatment, surveillance is recommended every 3-4 months for the first two years, and every 6 months up to 5 years.
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