Guidelines on the management of endometrial cancer were published on March 21, 2022 by the Spanish Society of Medical Oncology (SEOM) and the Spanish Group for Investigation in Ovarian Cancer (GEICO), in Clinical and Translational Oncology.
Routine screening for endometrial cancer is not recommended in women who are at average or high risk for endometrial cancer and do not have abnormal uterine bleeding; this includes patients on tamoxifen.
In women with Lynch syndrome, screen for endometrial cancer with annual endometrial sampling, transvaginal ultrasound (TVUS), and CA125 measurement, beginning at age 30–35, or 5–10 years prior to the earliest age of first diagnosis of Lynch-associated cancer of any kind.
Metrorrhagia should always be investigated in postmenopausal women or those with risk factors, using TVUS with a cutoff level of 3 mm.
Standard surgical treatment in early-stage endometrial cancer is total hysterectomy and bilateral salpingo-oophorectomy without vaginal cuff resection, using a minimally invasive surgery approach.
In low-risk endometrial cancer, systematic lymph node dissection (LND) is not recommended. In intermediate and high-risk cases, LND is recommended to guide surgical staging and adjuvant therapy. Sentinel lymph node biopsy can be considered for staging purposes.
Adjuvant treatment recommendations are as follows:
Low-risk patients – Adjuvant treatment not required
Intermediate-risk patients – Vaginal brachytherapy (VBT); VBT plus pelvic radiation in patients with no surgical nodal staging
High-risk patients - Adjuvant chemotherapy (carboplatin-paclitaxel) with concurrent or sequential external beam radiation therapy, or chemotherapy alone
Hormonal therapy could be an appropriate therapeutic alternative for patients with low-grade, hormone-receptor–positive disease, without rapidly progressive metastatic disease. The treatment of choice is progestogens or progestogens alternating with tamoxifen.
Pembrolizumab plus lenvatinib should be considered for second-line treatment, particularly for mismatch repair (MMR)–proficient tumors; dostarlimab or pembrolizumab can be considered for second-line therapy of MMR-deficient tumors.
Surveillance consists mainly of monitoring symptoms and physical examination that includes a speculum and pelvic examination every 3–6 months for 2 years, and every 6–12 months thereafter. Patients with low-risk endometrial cancer can be followed less frequently: 6–12 months for first 2 years, then yearly thereafter. Follow-up imaging may be useful in selected high-risk patients.
For more information, please go to Endometrial Carcinoma.
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Cite this: Endometrial Cancer Clinical Practice Guidelines (SEOM/GEICO, 2022) - Medscape - Apr 01, 2022.