Endometrial Cancer: Rapid Evidence Review

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.