Endometrial Cancer

Conclusions

There is no cost-effective screening program for asymptomatic patients, although high risk patients should be evaluated with ultrasonography and endometrial sampling. High risk factors are patients over 40 years of age with abnormal uterine bleeding, massively obese patients, a history of hyperplasia, and a history of unopposed use of estrogen or tamoxifen. Women with abnormal uterine bleeding should undergo endometrial biopsy; those with persistent bleeding, inadequate samples, or hyperplasia should undergo D&C and hysteroscopy. Once a cancer is diagnosed, the treatment is initially surgical for most patients. Staging is performed using the FIGO system, which is based on surgical findings and pathology reports. FIGO stage and tumor grade determine the need for postoperative adjuvant therapy as well as the irradiation technique if it is used. A clinical stage can be assigned for advanced disease, and for such patients irradiation may be used as an alternative to surgery for the initial treatment. Recurrent disease is treated with surgery, irradiation, chemotherapy, or progestins depending on the site of recurrence and method of treating the primary disease.