Treatment The principle of treatment for endometrial cancer should be based on the patient’s age, physical condition, lesion scope and histological type to select the appropriate treatment modality. Since most of endometrial cancers are adenocarcinomas, which are not very sensitive to radiotherapy, surgery is the main treatment, and other comprehensive treatments such as radiotherapy and chemotherapy are also available. For early stage patients, surgery is the main treatment, and adjuvant treatment is chosen according to the results of surgery-pathological staging and high risk factors for recurrence; for advanced stage patients, surgery, radiotherapy and chemotherapy are combined treatments. 1.Surgery Surgery is the main treatment method for endometrial cancer. For early stage patients, the purpose of surgery is to operate – pathological staging, accurately determine the lesion scope and prognosis related, remove the diseased uterus and possible metastatic lesions, and decide the choice of postoperative adjuvant therapy. The surgical steps generally include abdominal washout examination, extra-fascial total hysterectomy, bilateral ovarian and tubal resection, and pelvic lymph node dissection +/- para-abdominal aortic lymph node dissection. It is controversial whether lymph node dissection is required for patients in the low-risk group (stage Ia, G1-2). Proponents believe that the preoperative and postoperative pathological types and differentiation may be inconsistent, and that intraoperative freezing may also be inaccurate in determining myofibrotic infiltration; opponents believe that the lymph node metastasis rate of early-stage cancer is low, and that no lymph node dissection can avoid more surgical complications. The surgery can be done by open or laparoscopic. For stage II patients, the procedure should be modified extensive hysterectomy (hysterectomy for cervical cancer type II procedure), and pelvic lymph node and para-aortic lymph node dissection should be performed. Postoperative radiotherapy should be selected according to recurrence factors, and stage III or IV patients should be shrunken as much as possible to create conditions for postoperative radiotherapy. A significant proportion of patients with early stage endometrial cancer can be cured by standard surgery alone, but for patients with high risk of recurrence by surgery-pathological staging or advanced stage, certain adjuvant therapy is required after surgery. Since patients with endometrial cancer are often older and have more comorbidities, such as hypertension, diabetes, obesity, and other cardiovascular and cerebrovascular diseases, it is necessary to evaluate their physical tolerance in detail and give individualized treatment to each patient. 2. Radiotherapy is one of the effective methods to treat endometrial cancer. Radiotherapy alone is only applicable to those who are too old and frail and have serious medical comorbidities to tolerate surgery or are contraindicated to surgery, as well as those who are not suitable for surgery at stage III or above, including intracavitary and extracorporeal irradiation. Pre-operative radiotherapy is rarely used, but for patients with heavy vaginal bleeding, poor general condition, many comorbidities and unable to tolerate surgery in the short term, radiotherapy can be used first to stop bleeding and control disease progression. After the patient’s general condition improves, total hysterectomy + double adnexal resection is feasible. Preoperative radiotherapy is mainly intracavitary radiotherapy. Postoperative adjuvant radiotherapy is more frequently used in clinical practice. Indications for postoperative radiotherapy: lymph node metastasis or suspected lymph node metastasis on surgical exploration; myometrial infiltration greater than 1/2 or G2, G3; special histological types, such as plasmacytoma, clear cell carcinoma, etc.; residual vaginal cutting edge carcinoma, etc. The first three cases mentioned above are given total pelvic irradiation, and the last case needs to be supplemented with intracavitary radiotherapy. At present, radiotherapy is mostly combined with chemotherapy for sensitization, which is also called radiotherapy. Chemotherapy is rarely applied to endometrial cancer treatment alone, but mostly used for special types of endometrial cancer, such as plasmacytosis, clear cell carcinoma, etc.; or recurrent cases; or post-surgical patients with high risk factors for recurrence, such as G3, ER/PR negative patients. The main drugs applied in chemotherapy are platinum, paclitaxel and adriamycin, such as doxorubicin. At present, combined chemotherapy is mostly used, and chemotherapy regimens include AP, TP, TAP, etc. 4.Hormone therapy Indications: advanced or recurrent patients; endometrial cancer patients with preserved fertility; conservative surgery combined with high-dose progestin to preserve ovarian function; postoperative adjuvant therapy for patients with high-risk factors. Contraindications: hepatic and renal insufficiency; severe cardiac insufficiency; history of thrombosis; patients with diabetes mellitus; those with mental depression; those with allergy to progestins; patients with meningioma. There is no universally accepted progestin treatment regimen, and it is generally advocated to apply high-dose progestin alone, such as medroxyprogesterone acetate, megestrol acetate, 17-hydroxyprogesterone, and 18-methylprogesterone. It is generally considered that the duration of application should not be less than 1-2 years. High-dose progestins are more effective in pathological specimens with positive immunohistochemical progesterone receptors, with an efficiency rate of up to 80% for those with preserved reproductive function and an overall response rate of 15%-25% for patients with advanced or recurrent disease. For progestin receptor-negative patients, triamcinolone acetonide can be added to reverse the receptor-negative condition and improve the treatment effect. Common side effects of progestin drugs include mild water and sodium retention and gastrointestinal reactions, and others may include hypertension, acne, and breast pain. 5.Chinese medicine treatment After surgery and radiotherapy, patients can be given Chinese herbal medicine treatment to strengthen the root and support the righteousness and improve the immunity of the patient’s body.