Management of early-stage endometrial cancer

Endometrial cancer is the most common gynecologic malignancy in the United States. The majority of women are diagnosed with early-stage disease. Surgical therapy of early-stage endometrial cancer includes full staging, including pelvic and para-aortic lymphadenectomy. While most women with early-stage endometrial cancer can anticipate cure with surgery alone, a significant minority of women with deeply invasive or high-grade tumors will experience local, regional, or distant recurrences of their disease. Therefore, adjuvant therapies have been proposed for these women. While radiotherapy is effective at reducing the risk of local and regional tumor recurrence, studies have demonstrated no improvement on survival. The role of systemic adjuvant chemotherapies in this high-risk, early-stage patient population is currently the focus of several randomized trials. In addition, for women with early-stage tumors with atypical histology, such as papillary serous and clear cell malignancies, the role of adjuvant therapy remains uncertain. Optimizing management of women with early-stage disease requires a careful assessment of the risk of recurrent disease, the potential benefit of various adjuvant strategies, and the risk associated with adjuvant therapy. New molecular markers may be helpful in the future to refine our ability to identify high-risk, early-stage patients.