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Endometrial%20cancer Management
Observation
- Recommended follow-up intervals for surveillance of signs and symptoms suggestive of recurrence after surgery are as follows:
- For low-risk patients, history and physical examination: Every 6 months for 1 year, then every 6-12 months 1-2 years post-treatment, and yearly thereafter
- For high-risk patients, history and physical examination: Every 3 months for 1 year, then every 3 months 1-2 years post-treatment, every 6 months after >2 years, and yearly after >5 years post-treatment
- If recurrence is highly likely, may consider CT scan or PET/CT scan with or without CA-125 testing
- Recommended follow-up intervals for surveillance of signs and symptoms for patients who did not undergo surgical treatment and opted for fertility-sparing regimens (eg progestin-based therapy) are as follows:
- Endometrial sampling every 3-6 months
- If complete response to therapy seen at 6 months after initiation of therapy, continue surveillance every 3-6 months until pregnancy occurs
Follow Up
- For patients who underwent fertility-sparing treatments, recurrence rates are 30-40%
- Treatment response should be assessed using dilatation and curettage, hysteroscopy, and imaging studies on the 6th month following completion of therapy
- For patients with persistent disease due to treatment failure after 6 months of initial therapy, pelvic MRI is recommended especially for those considering further fertility-sparing regimens
- Patients on progestin-based treatment should be monitored every 3-6 months, with dilation and curettage, hysteroscopy, and imaging
- Re-evaluation every 6 months should be imposed on patients who did not undergo hysterectomy
- Progesterone receptor (PgR) may be used to predict disease remission
- Patients with good response to treatment should be referred to fertility clinics
- For patients who underwent fertility-sparing treatments, EH-BSO with staging is recommended for the following:
- After childbirth
- Presence of disease progression in biopsies
- Persistent endometrial cancer after 6-12 months of progestin-based therapy
- Patients with FIGO stage II-IV disease who chose non-fertility-sparing treatments should be re-evaluated using chest/abdominal/pelvic CT every 6 months for the first 3 years after therapy, and every 6-12 months for the next 2 years
- Other imaging modalities may be considered in patients with possible disease progression, new masses on PE, or new pelvic, abdominal or lung symptoms during follow-up
- For patients with persistent endometrial cancer still desiring pregnancy, repeat pelvic MRI should be performed
