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endometrial%20cancer
ENDOMETRIAL CANCER

Endometrial cancer is also known as uterine cancer, cancer of the corpus uteri, uterine corpus cancer, endometrical carcinoma.

It is the 6th most common malignancy worldwide.

Management of endometrial cancer should be divided based on risk, disease stage & patient's desire for fertility.

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
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