Fact or Fiction: Endometrial Cancer

Medscape

2 days ago

Recent research emphasizes the importance of recognizing subclinical and early-stage endometrial cancer and the risks associated with delayed diagnosis, particularly among patients with metabolic syndrome, obesity, or other chronic health conditions. Improvements in diagnostic techniques and treatment modalities allow for a patient-centered, personalized approach, focusing not only on tumor eradication but also on overall health, quality of life, and long-term well-being.
Although hormonal imbalance, particularly excess estrogen without sufficient progesterone, contributes significantly to the development of endometrial cancer, numerous other factors play critical roles. Specifically, women with Lynch syndrome have the highest risk for endometrial cancer (40%-60% lifetime risk), and research has shown that obesity and insulin resistance also drive its pathogenesis. Lifestyle factors, such as alcohol consumption and tobacco use, and psychological factors can further influence pathogenesis and prognosis.
Learn more about the etiology of endometrial cancer.
Total hysterectomy with bilateral salpingo-oophorectomy is the standard surgery for endometrial cancer, except in candidates for fertility-sparing options. Decisions regarding the addition of chemotherapy, radiation, or both depend on factors such as tumor stage, histologic subtype, grade, lymphovascular invasion, and molecular classification (eg, POLE mutations, p53 status, or mismatch repair deficiency). This individualized approach ensures that patients with low-risk disease are not overtreated while those with high-risk or advanced disease receive more aggressive and effective multimodal therapy.
Learn more about treatment of endometrial cancer.
Although hysterectomy is a key component of treatment, especially when performed with bilateral salpingo-oophorectomy, endometrial cancer can still recur. Up to 20% of patients will experience recurrence after hysterectomy, with most cases occurring within 2-3 years. Further, relapses can be local or include distant extrauterine manifestations. Therefore, ongoing surveillance through regular follow-up appointments, and imaging when necessary, is part of comprehensive care in both American and European recommendations.
Learn more about the workup for endometrial cancer.
Approximately 90% of patients with endometrial cancer will present with abnormal vaginal bleeding, with most cases occurring post-menopause. This has led to a belief that endometrial cancer is highly treatable because most patients with abnormal bleeding causes seek care when the cancer is still in early stages. However, mortality due to uterine cancer, of which endometrial cancer is the largest subgroup, has increased 1.25 times in all age groups throughout the 2000s. After presentation, an endometrial sample, which is easily obtained through office endometrial biopsy, can confirm the diagnosis, and further testing is then done to guide the course of treatment.
Learn more about management guidelines for endometrial cancer.
When fertility-sparing therapies are used in correctly selected patients, there is no significant adverse impact on survival. Specifically, patients with stage 1 endometrial cancer treated with fertility-sparing progestin therapy had comparable 5-year survival rates to those treated with hysterectomy, but comparable survival outcomes were not seen in those with higher-stage disease. According to National Comprehensive Cancer Network guidelines, patients must meet all of these criteria to be candidates for fertility-sparing treatment: grade 1 histology, disease limited to endometrium, absence of suspicious metastases, no contraindications to therapy or pregnancy, and counseling that this is not the standard of care.
Learn more about management approaches to endometrial cancer.