The diagnosis and treatment of endometrial cancer: progress and controversies

Endometrial carcinoma is the fourth most common type of cancer among women in Germany, with more than 11 000 newly diagnosed cases each year. The present lack of clarity about the optimal clinical management of these patients is due in part to inconsistencies in the scientific evidence and in part to recent modifications of the FIGO classification. In this article, the issues requiring clarification are presented and discussed.

This article is based on a selective review of the pertinent literature, including evidence-based guidelines and recommendations.

Current scientific evidence does not support the screening of asymptomatic women. On the other hand, women with postmenopausal and acyclic bleeding should undergo histopathological evaluation, particularly if they have risk factors for endometrial cancer. The current FIGO classification divides endometrial cancer into stages depending on the findings at surgery. On the basis of risk stratification (e.g., by tumor stage and histological differentiation grade), women who are judged to be at high risk (FIGO Stage IB and above, Grade 3) should undergo not just hysterectomy and adnexectomy, but also systematic pelvic and para-aortic lymphadenectomy. Risk stratification also determines whether adjuvant radiotherapy should be given. The additional or alternative administration of chemotherapy is a particular consideration for women at high risk, although the pertinent clinical trials to date have yielded conflicting evidence on this point.