Locations:
Search IconSearch
October 16, 2018/Cancer

How Sentinel Lymph Node Detection Is Improving Care for Endometrial Cancer Patients

Minimally invasive staging technique improves accuracy, reduces complications

DeBernardo, MD

Approximately 80 to 85 percent of patients with endometrial cancer survive long-term. But what about the small percentage of patients who end up dying from metastatic disease? When endometrial cancer is diagnosed, using the most accurate staging and treatment strategies is key to delivering optimal patient outcomes — especially when managing aggressive forms of the disease.

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Minimally invasive staging techniques are enabling Ob/Gyn specialists to provide higher quality care to endometrial cancer patients. In this article, Robert DeBernardo, MD, a gynecologic oncologist and Director of the Peritoneal Surface Malignancy Program, discusses how sentinel lymph node detection provides a higher rate of cancer detection while reducing the risk of long-term complications.

Q: How has endometrial cancer treatment changed over the past 10 years?

A: We used to treat endometrial cancer by performing an abdominal hysterectomy. Now, we’re primarily using robotic or laparoscopic hysterectomy — and achieving similar or better patient outcomes. Minimally invasive techniques are now the preferred standard of care for both treatment and staging.

Q: What controversy has developed over surgical staging?

A: At the time of surgery, we have the option of removing lymph nodes to check for metastases. For patients with high-risk cancer with a poor prognosis, removing lymph nodes provides valuable information that will impact the treatment plan and our ability to cure endometrial cancer.

Removing lymph nodes involves significant risk. In fact, about 10 to 20 percent of patients will experience some type of complication following lymphadenectomy. The most significant complication is lymphedema, which can lead to long-term mobility issues.

Q: What is the goal of assessing lymph node involvement?

A: Most patients with endometrial cancer have a low risk of lymph node involvement. So there are two key questions at play: How do we identify candidates for surgical staging? And how many lymph nodes should be removed? Because of the risk of complications, we have to be somewhat selective. For example, if there’s a 1 percent chance that your lymph node could be positive, it’s probably not reasonable to remove 20 or 30 lymph nodes. If you have a 30 to 40 percent chance of involvement, lymphadenectomy is an option well worth considering.

Advertisement

Q: How is sentinel lymph node detection used to stage endometrial cancer?

A: The sentinel lymph node technique has been used to identify lymph node metastasis in patients with melanoma, breast cancer and vulvar cancer. In patients with endometrial cancer, instead of injecting the tumor directly, we inject the cervix with the tracer dye. This technique still correlates well and reveals the activity of other lymph nodes. It also helps determine if radiation and chemotherapy should be used following a hysterectomy.

Q: How is the injection dye used?

A: We use an indocyanine green (ICG) dye that fluoresces so we can easily identify the lymphatic channels. This makes removing a sentinel lymph node very easy, avoiding complete lymph node dissection. By only removing the pertinent lymph nodes, we achieve a higher rate of metastatic cancer detection with fewer complications.

Q: Why is it important for Ob/Gyns to consider this staging technique before finalizing a patient’s treatment plan?

A: Sentinel lymph node detection can’t be used once a hysterectomy is performed. Patients at moderate or high risk will need a second surgery to remove all the lymph nodes or receive adjuvant radiation and/or chemotherapy to reduce the risk of recurrence. Patients being considered for endometrial cancer surgery should see a specialist with experience in sentinel lymph node detection.

Q: Are you aware of any research being conducted in support of this type of sentinel lymph node detection?

A: Future research will be used to assess the long-term cancer outcomes associated with sentinel lymph node detection in endometrial cancer patients. We expect them to be favorable.

Advertisement

To further advance cancer detection technology, we’re working on a bioengineering project that uses augmented reality to identify cancers and their resectability. The project is designed to capture computed tomography (CT or CAT) scans and magnetic resonance imaging (MRI) and create 3D images of patients. This will allow physicians to examine tumor location in relation to internal organs for more precise staging and treatment development.

Advertisement

Related Articles

scan showing cholangiocarcinoma
June 5, 2025/Cancer/News & Insight
Exploring Novel Therapeutic Avenues in Advanced Cholangiocarcinoma: Lessons from the EA2187 Trial

Collaborative research effort underscores the urgent need for effective second-line therapies in this rare, aggressive cancer

Anticoagulant sign
June 4, 2025/Cancer/News & Insight
Direct-Acting Oral Anticoagulants Safe for Patients with Brain Metastasis

Largest study to date comparing direct-acting oral anticoagulants to low-molecular-weight heparin

Squamous cell carcinoma
June 2, 2025/Cancer/News & Insight
Adjuvant Immunotherapy in High-Risk Cutaneous Squamous Cell Carcinoma

Pembrolizumab does not improve outcomes, but immunotherapy may still offer benefit

Photonic sensor
May 22, 2025/Cancer/News & Insight
Novel Partnership Aims to Advance ctDNA Testing in Non-Small Cell Lung Cancer

Cleveland Clinic, the University of Minnesota and University of Cambridge receive $1M grant to develop point-of-care biosensor for early detection and treatment personalization

gastroesophageal cancer illustration
May 20, 2025/Cancer/News & Insight
Roughly One-Third of Patients with Metastatic Gastroesophageal Cancer May be Eligible for New Targeted Therapy

Long-acting antiemetics and high-dose steroids key to minimizing acute nausea

Neoadjuvant immunotherapy
May 16, 2025/Cancer/News & Insight
Changing Course in Treating Advanced Melanoma

Neoadjuvant immunotherapy improves outcomes

Dr. Abhay Singh
May 14, 2025/Cancer
Managing Weight and Diabetes May Offer Promise for Blood Cancer Prevention (Podcast)

Use of GLP-1s and improving cardiovascular health lowers risk of hematologic malignancies

Ad