Incidence and mortality rates associated with endometrial cancer are increasing in the United States. Risk factors include obesity, unopposed estrogen states, estrogen-producing tumors, younger age at menarche, nulliparity, late menopause, and tamoxifen use. There are no recommendations for endometrial cancer screening in individuals at average risk. Abnormal uterine bleeding, especially postmenopausal bleeding, is the most common symptom. Patients who present with postmenopausal bleeding should be evaluated with pelvic ultrasonography or endometrial biopsy. The diagnosis of endometrial cancer is made with endometrial biopsy, most often with Pipelle endometrial sampling. Dilation and curettage is recommended if an adequate sample cannot be obtained, the diagnosis is unclear, or a focal lesion such as an endometrial polyp or mass is present. Treatment of early-stage disease is primarily surgical. Radiation therapy decreases recurrence rates but not survival rates in early-stage cancers. Chemotherapy, hormone therapy, and biologic therapy are used to treat advanced endometrial cancer, and clinical trials are ongoing. Complementary medicine therapies can improve quality of life and survival rates in patients undergoing treatment. Patients should be referred to a gynecologic oncologist; early-stage treatment is associated with longer survival rates. Endometrial cancer survivors should undergo periodic surveillance that includes a history and physical examination.
Endometrial cancer is the fourth most common type of cancer in women in the United States, and its incidence has increased in an aging population with growing rates of obesity.1,2 This rapid evidence review highlights the current best evidence and clinical recommendations on the diagnosis and treatment of endometrial cancer in the primary care setting.
WHAT'S NEW ON THIS TOPIC
| North America has the highest global incidence of endometrial cancer. The mortality rate has increased from 2.5 deaths/100,000 individuals in 1999 to 3.9 deaths/100,000 individuals in 2020. |
| Patients diagnosed with early-stage endometrial cancer remain more likely to die of cardiovascular disease than cancer. |
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comment |
|---|---|---|
| Do not prescribe unopposed estrogen therapy to patients with a uterus.4,7,8,13 | A | Consistent evidence that use of estrogen without a progestin increases the risk of endometrial cancer |
| Postmenopausal patients who present with abnormal uterine bleeding should be evaluated for endometrial cancer with pelvic ultrasonography or endometrial biopsy as a first-line test.8,18,19 | C | High-quality studies demonstrating performance characteristics of each, expert opinion, usual practice |
| In premenopausal women, ultrasound measurement of endometrial thickness has no diagnostic value and should not be performed.8 | C | Consensus recommendation based on usual practice and expert opinion |
| Patients with negative results from pelvic ultrasonography or endometrial biopsy but persistent abnormal uterine bleeding should undergo further evaluation.23 | C | Studies of test performance characteristics, expert opinion, usual practice |
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.
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