Endometrial Carcinoma Treatment & Management

  • Author: William T Creasman, MD; Chief Editor: Warner K Huh, MD  more...
Updated: Sep 08, 2016

Approach Considerations

Standard management of endometrial cancer at diagnosis involves surgery, followed by chemotherapy with or without radiation therapy.[1]  In the setting of recurrent disease, secondary cytoreduction has been associated with progression-free (PFS) and overall (OS) survival.[12] Prognostic factors for improved long-term OS were the absence of residual disease following surgical resection and histotype.[12]

Lymph node metastasis is an important concern in patients with high-risk early or advanced endometrial cancer.[13, 14] In evaluating data from 523 French surgical patients over a 12-year period, Bendifallah et al developed a predictive model to identify those at high risk for lymph node metastases using the histopathologic features of histologic grade, tumor diameter, depth of myometrial invasion, and status of lymphovascular space involvement.[13] In a different study, Fotopoulou et al reported that, on the basis of anatomic distribution of positive lymph nodes, when lymphadenectomy is performed for those with high-risk early or advanced disease, the procedure should contain pelvic and para-aortic areas up to the renal vessels to ensure accuracy in the evaluation of all potential positive nodes.[14]


Surgical Care

Since 1988, FIGO, whose Gynecologic Oncology Committee was responsible for the staging of gynecological cancer, recommended that corpus cancer be staged surgically. Previously, clinical evaluation was used for staging, and multiple studies noted the inaccuracy of clinical staging compared with surgical pathological findings. Therefore, once the diagnosis of endometrial cancer has been made, routine presurgical evaluation is performed to assess operability.

Note the following:

  • Special studies, such as CT scans of the abdomen and pelvis or MRIs, are not routinely performed.
  • Once preoperative evaluation, which may include a chest radiograph, ECG, and appropriate blood studies, has been performed and the results are found to be normal, the patient is deemed a surgical candidate. Then, an exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal cytology, and pelvic and para-aortic lymphadenectomy are performed.
  • Obviously, if intraperitoneal disease is identified at the time of surgery, attempts are made at surgical removal.
  • Staging is then determined based on surgical pathologic findings (see Staging). Subsequent therapy, if needed, is then determined, depending on the surgical pathological findings of the operative procedure.
  • Data extracted from the SEER database indicate that among women younger than 60 years with stage 1B and 1C endometrioid adenocarcinoma who underwent lymphadenectomy were less likely to undergo full pelvic radiation and more likely to receive brachytherapy; furthermore, the extent of lymphadenectomy influenced the receipt of radiotherapy. [15]

A 2012 review found that for early stage primary endometrioid adenocarcinoma of the endometrium, laparoscopy and laparotomy are associated with similar rates of disease-free and overall survival and that laparoscopy is associated with reduced operative morbidity and shorter hospital stays.[16]

Contributor Information and Disclosures

William T Creasman, MD J Marion Sims Distinguished University Professor, Department of Obstetrics and Gynecology, Medical University of South Carolina College of Medicine

William T Creasman, MD is a member of the following medical societies: North Carolina Medical Society, Society of Gynecologic Oncology, American College of Obstetricians and Gynecologists, American Gynecological and Obstetrical Society, American Medical Association, South Carolina Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Jori S Carter, MD, MS Assistant Professor, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine

Jori S Carter, MD, MS is a member of the following medical societies: Alpha Omega Alpha, American College of Obstetricians and Gynecologists, Society of Gynecologic Oncology, Association of Women Surgeons, International Society for Magnetic Resonance in Medicine, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Chief Editor

Warner K Huh, MD Professor, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Senior Scientist, Comprehensive Cancer Center, University of Alabama School of Medicine

Warner K Huh, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American College of Surgeons, Massachusetts Medical Society, Society of Gynecologic Oncology, American Society of Clinical Oncology

Disclosure: I have received consulting fees for: Merck; THEVAX.

Additional Contributors

John J Kavanagh, Jr, MD Chief, Professor, Department of Internal Medicine, Section of Gynecological and Medical Therapeutics, MD Anderson Cancer Center, University of Texas Medical School at Houston

John J Kavanagh, Jr, MD is a member of the following medical societies: American Association for the Advancement of Science, Society of Gynecologic Oncology, American Association for Cancer Research, American Association for the History of Medicine, American College of Physicians, American Federation for Medical Research, American Medical Association, Southern Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.


Medscape Drugs & Diseases thanks Tarek Bardawil, MD, Assistant Professor, Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, for assistance with the video contribution to this article.

  1. de Haydu C, Black JD, Schwab CL, English DP, Santin AD. An update on the current pharmacotherapy for endometrial cancer. Expert Opin Pharmacother. 2015 Dec 2. [Medline].

  2. National Cancer Institute. SEER stat fact sheets: endometrial cancer. Surveillance, Epidemiology, and End Results (SEER) Program. Available at http://seer.cancer.gov/statfacts/html/corp.html. Accessed: 24 Nov 2015.

  3. Bernstein L, Deapen D, Cerhan JR, et al. Tamoxifen therapy for breast cancer and endometrial cancer risk. J Natl Cancer Inst. 1999 Oct 6. 91(19):1654-62. [Medline].

  4. Creasman WT. Endometrial cancer: incidence, prognostic factors, diagnosis, and treatment. Semin Oncol. 1997 Feb. 24(1 Suppl 1):S1-140-S1-50. [Medline].

  5. Bjorge T, Stocks T, Lukanova A, et al. Metabolic syndrome and endometrial carcinoma. Am J Epidemiol. 2010 Apr 15. 171(8):892-902. [Medline].

  6. Kernochan LE, Garcia RL. Carcinosarcomas (malignant mixed Müllerian tumor) of the uterus: advances in elucidation of biologic and clinical characteristics. J Natl Compr Canc Netw. 2009 May. 7(5):550-6; quiz 557. [Medline].

  7. Saunders R. Biomarker predicts recurrence of endometrial cancer. Medscape Medical News from WebMD. July 11, 2013. Available at http://www.medscape.com/viewarticle/807678. Accessed: July 23, 2013.

  8. Zeimet AG, Reimer D, Huszar M, et al. L1CAM in early-stage type I endometrial cancer: results of a large multicenter evaluation. J Natl Cancer Inst. 2013 Aug 7. 105(15):1142-50. [Medline].

  9. Kilgore LC, Partridge EE, Alvarez RD. Adenocarcinoma of the endometrium: survival comparisons of patients with and without pelvic node sampling. Gynecol Oncol. 1995 Jan. 56(1):29-33. [Medline].

  10. Chan JK, Cheung MK, Huh WK, et al. Therapeutic role of lymph node resection in endometrioid corpus cancer: a study of 12,333 patients. Cancer. Oct 15 2006. 107(8):1823-30. [Medline].

  11. Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet. 2009 May. 105(2):103-4. [Medline].

  12. Papadia A, Bellati F, Ditto A, et al. Surgical treatment of recurrent endometrial cancer: time for a paradigm shift. Ann Surg Oncol. 2015 Dec. 22 (13):4204-10. [Medline].

  13. Bendifallah S, Canlorbe G, Laas E, et al. A predictive model using histopathologic characteristics of early-stage type 1 endometrial cancer to identify patients at high risk for lymph node metastasis. Ann Surg Oncol. 2015 Dec. 22 (13):4224-32. [Medline].

  14. Fotopoulou C, El-Balat A, du Bois A, et al. Systematic pelvic and paraaortic lymphadenectomy in early high-risk or advanced endometrial cancer. Arch Gynecol Obstet. 2015 Dec. 292 (6):1321-7. [Medline].

  15. Sharma C, Deutsch I, Lewin SN, et al. Lymphadenectomy influences the utilization of adjuvant radiation treatment for endometrial cancer. Am J Obstet Gynecol. 2011 Dec. 205(6):562.e1-9. [Medline].

  16. Galaal K, Bryant A, Fisher AD, Al-Khaduri M, Kew F, Lopes AD. Laparoscopy versus laparotomy for the management of early stage endometrial cancer. Cochrane Database Syst Rev. 2012 Sep 12. 9:CD006655. [Medline].

  17. [Guideline] National Cancer Institute. Endometrial Cancer Screening–for health professionals (PDQ®). National Cancer Institute. Available at http://www.cancer.gov/cancertopics/pdq/screening/endometrial/HealthProfessional/page1. March 4, 2016; Accessed: September 5, 2016.

  18. [Guideline] Smith RA, Andrews K, Brooks D, DeSantis CE, Fedewa SA, Lortet-Tieulent J, et al. Cancer screening in the United States, 2016: A review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin. 2016 Mar-Apr. 66 (2):96-114. [Medline]. [Full Text].

  19. [Guideline] National Comprehensive Cancer Network. Genetic/Familial High-Risk Assessment: Colorectal, V1.2016. NCCN. Available at https://www.nccn.org/professionals/physician_gls/pdf/colorectal_screening.pdf. June 23, 2016; Accessed: September 5, 2016.

  20. [Guideline] Committee on Practice Bulletins-Gynecology, Society of Gynecologic Oncology. ACOG Practice Bulletin No. 147: Lynch syndrome. Obstet Gynecol. 2014 Nov. 124 (5):1042-54. [Medline]. [Full Text].

  21. [Guideline] Colombo N, Creutzberg C, Amant F, Bosse T, González-Martín A, Ledermann J, et al. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: diagnosis, treatment and follow-up. Ann Oncol. 2016 Jan. 27 (1):16-41. [Medline]. [Full Text].

  22. [Guideline] National Comprehensive Care Network. Uterine Neoplasms. Version 2.2015. NCCN. Available at http://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf. Accessed: June 26, 2015.

  23. [Guideline] SGO Clinical Practice Endometrial Cancer Working Group, Burke WM, Orr J, Leitao M, Salom E, Gehrig P, et al. Endometrial cancer: a review and current management strategies: part I. Gynecol Oncol. 2014 Aug. 134 (2):385-92. [Medline]. [Full Text].

  24. [Guideline] Colombo N, Preti E, Landoni F, Carinelli S, Colombo A, Marini C, et al. Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013 Oct. 24 Suppl 6:vi33-8. [Medline]. [Full Text].

  25. Corpus Uteri. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC Cancer Staging Manual. 7th Ed. New York: Springer-Verlag; 2010. 403-18.

  26. [Guideline] Practice Bulletin No. 149: Endometrial cancer. Practice Bulletin No. 149: Endometrial cancer. Obstet Gynecol. 2015 Apr. 125 (4):1006-26. [Medline].

  27. [Guideline] SGO Clinical Practice Endometrial Cancer Working Group, Burke WM, Orr J, Leitao M, Salom E, Gehrig P, et al. Endometrial cancer: a review and current management strategies: part II. Gynecol Oncol. 2014 Aug. 134 (2):393-402. [Medline]. [Full Text].

  28. [Guideline] Klopp A, Smith BD, Alektiar K, Cabrera A, Damato AL, Erickson B, et al. The role of postoperative radiation therapy for endometrial cancer: Executive summary of an American Society for Radiation Oncology evidence-based guideline. Pract Radiat Oncol. 2014 May-Jun. 4 (3):137-44. [Medline]. [Full Text].

  29. [Guideline] Salani R, Backes FJ, Fung MF, Holschneider CH, Parker LP, Bristow RE, et al. Posttreatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncologists recommendations. Am J Obstet Gynecol. 2011 Jun. 204 (6):466-78. [Medline]. [Full Text].

  30. American College of Obstetricians and Gynecologists. Estrogen replacement therapy and endometrial cancer. ACOG Committee Opinion: Committee on Gynecologic Practice Number 126--August 1993. Int J Gynaecol Obstet. 1993 Oct. 43(1):89. [Medline].

  31. Creasman WT, Kohler MF, Odicino F, Maisonneuve P, Boyle P. Prognosis of papillary serous, clear cell, and grade 3 stage I carcinoma of the endometrium. Gynecol Oncol. 2004 Dec. 95(3):593-6. [Medline].

  32. Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer. 1987 Oct 15. 60(8 Suppl):2035-41. [Medline].

  33. DiSaia PJ, Creasman WT. 7th ed. Clinical Gynecologic Oncology. St. Louis, Mo: Mosby; 2007.

  34. Douglas D. Similar outcomes with oral and IUD hormonal therapy for endometrial neoplasms. Medscape Medical Newsfrom WebMD. May 15, 2013. Available at http://www.medscape.com/viewarticle/804217. Accessed: June 3, 2013.

  35. Ferenczy A, Gelfand M. The biologic significance of cytologic atypia in progestogen-treated endometrial hyperplasia. Am J Obstet Gynecol. 1989 Jan. 160(1):126-31. [Medline].

  36. Goff BA, Kato D, Schmidt RA, et al. Uterine papillary serous carcinoma: patterns of metastatic spread. Gynecol Oncol. 1994 Sep. 54(3):264-8. [Medline].

  37. Hubbs JL, Saig RM, Abaid LN, Bae-Jump VL, Gehrig PA. Systemic and local hormone therapy for endometrial hyperplasia and early adenocarcinoma. Obstet Gynecol. 2013 Jun. 121(6):1172-80. [Medline].

  38. Kadar N, Malfetano JH, Homesley HD. Determinants of survival of surgically staged patients with endometrial carcinoma histologically confined to the uterus: implications for therapy. Obstet Gynecol. 1992 Oct. 80(4):655-9. [Medline].

  39. Kurman RJ, Kaminski PF, Norris HJ. The behavior of endometrial hyperplasia. A long-term study of "untreated" hyperplasia in 170 patients. Cancer. 1985 Jul 15. 56(2):403-12. [Medline].

  40. Mariani A, Dowdy SC, Keeney GL, et al. High-risk endometrial cancer subgroups: candidates for target-based adjuvant therapy. Gynecol Oncol. 2004 Oct. 95(1):120-6. [Medline].

  41. Morrow CP, Bundy BN, Kurman RJ, et al. Relationship between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: a Gynecologic Oncology Group study. Gynecol Oncol. 1991 Jan. 40(1):55-65. [Medline].

  42. Silverberg SG, Major FJ, Blessing JA, et al. Carcinosarcoma (malignant mixed mesodermal tumor) of the uterus. A Gynecologic Oncology Group pathologic study of 203 cases. Int J Gynecol Pathol. 1990. 9(1):1-19. [Medline].

  43. Trovik J, Wik E, Werner HM, et al. Hormone receptor loss in endometrial carcinoma curettage predicts lymph node metastasis and poor outcome in prospective multicentre trial. Eur J Cancer. 2013 Nov. 49(16):3431-41. [Medline].

  44. MIller D, Filiaci V, Fleming G, et al. Randomized phase III noninferiority trial of first line chemotherapy for metastatic or recurrent endometrial carcinoma: A Gynecologic Oncology Group study. Gynecol Oncol. 2012 June. 125(3):771.

Diagnostic hysteroscopy for endometrial cancer. Video courtesy of Tarek Bardawil, MD.
Table. Uterine Sarcomas (Leiomyosarcoma, Endometrial Stromal Sarcoma, and Adenosarcoma)
Primary tumor (T)
TNM FIGO stages Surgical-pathologic findings
TX   Primary tumor cannot be assessed
T0   No evidence of primary tumor
T1 I Tumor confined to uterus
T1a IA Tumor ≤5 cm
T1b IB Tumor >5 cm
T2a IIA Tumor extends to the pelvis, adnexal involvement
T2b IIB Tumor extends to extra-uterine pelvic tissue
T3a IIIA Tumor invades abdominal tissues, one site
T3b IIIB Tumor invades more than one site
T4 IVA Tumor invades bladder and/or rectum
Regional lymph nodes (N)
TNM FIGO stages Surgical-pathologic findings
NX   Regional lymph nodes cannot be assessed
N0   No regional lymph node metastasis
N1 IIIC Metastasis to pelvic and/or para-aortic lymph nodes
Distant metastasis (M)
TNM FIGO stages Surgical-pathologic findings
M0   No distant metastasis
M1 IVB Distant metastasis
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