ENDOMETRIUM
7. FOLLOW-UP
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Kemoterapi telah dibandingkan dengan radioterapi whole-abdomen pada suatu penelitian terandomisasi. Pasien-pasien kanker endometrium stadium III-IV setelah operasi dengan ukuran residu tumor maksimal sampai 2 cm, sebanyak 388 pasien dirandomisasi untuk menerima kemoterapi kombinasi cisplatin dan doxorubicin sebanyak 7 seri atau radioterapi whole-abdomen dengan dosis 30 Gy dalam 20 fraksi dan booster pelvis 15 Gy. Meskipun kekambuhan seringkali pada pelvis dan abdomen (55%), 2-year progression- free survival lebih baik dengan kemoterapi (59% berbanding 46%), demikian juga dengan overall survival (70% berbanding 59%) dengan p=0,01.29
141 8. REKOMENDASI
Kanker endometrium dikenal sebagai ―Cinderella‖-nya kanker ginekologi karena seringkali terdiagnosis secara dini, operasi secara umum menunjukkan kemajuan yang pesat, adjuvant radiasi seringkali digunakan, dan angka survival yang tinggi. Hal-hal yang dapat direkomendasikan untuk meningkatkan kewaspadaan terhadap kasus-kasus yang diduga kanker endometrium dan penanganannya untuk meningkatkan survival pasien antara lain:20,21
Wanita-wanita usia perimenopause dengan perdarahan uterus abnormal harus dieksplorasi untuk menyingirkan keganasan, salah satunya dengan tindakan dilatasi dan kuretasi.
Spesimen dilatasi dan kuretasi yang dikirim untuk pemeriksaan histopatologi selain meliputi jenis sel, juga dimintakan derajat diferensiasi sel.
Kasus-kasus kanker endometrium tipe 1 dengan derajat diferensiasi sel grade 1-2 perlu dievaluasi pre-operasi kedalaman invasi ke dalam miometrium.
Kasus-kasus kanker endometrium tipe 1, grade 1-2 dengan kedalaman invasi ke dalam miometrium kurang dari 50% dapat dilakukan tindakan histerektomi total dan salfingo-ooforektomi bilateral.
American College of Obstetricians and Gynecologist merekomendasikan kasus-kasus yang memerlukan tindakan ginekologi-onkologist atau oleh ginekologist yang terlatih dalam penanganan kanker ginekologis, antara lain:2,21
Hasil histologi pre-operasi menunjukkan derajat diferensiasi sel grade 3, jenis histologis sel papillary serous, clear cell, dan carcinosarcoma.
Hasil histopatologi menunjukkan kanker endometrium yang tidak diprediksi sebelumnya dari spesimen histerektomi, yang dilakukan operasi atas indikasi lain.
Terdapat kecurigaan penyebaran penyakit ekstra uterin.
Pasien yang tidak memungkinkan dilakukan tindakan operasi oleh karena masalah medis.
Curiga adanya kekambuhan.
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