Endometrial Cancer

After endometrial carcinoma is identified on endometrial sampling, document histologic type and grade, then obtain tumor molecular profiling early enough to inform multidisciplinary planning. Histologic type, grade, myometrial invasion, lymphovascular space invasion, and stage remain core clinicopathologic risk variables, but molecular classification now materially refines risk stratification. ScienceDirect+1ScienceDirectImproved Prognostic Stratification With 2023 International Federation of Gynecology and Obstetrics Staging in Endometrial Cancer Reflecting Poor Prognosis of Aggressive Histological Types and p53 Abnormality - ScienceDirectASCOImpact of Molecular Classification on Multidisciplinary ...

Order MMR immunohistochemistry, POLE exonuclease-domain mutation testing, and p53 assessment on diagnostic material or the hysterectomy specimen. This practical sequence identifies the four clinically used molecular groups: POLEmut, MMRd, p53abn, and no specific molecular profile (NSMP). MMR immunohistochemistry can identify the MSI phenotype, while p53 immunohistochemistry is a surrogate for TP53 status. Nature+1NatureA clinically applicable molecular-based classification for endometrial cancers | British Journal of CancerWileyFIGO staging of endometrial cancer: 2023 - Berek

Treat abnormal MMR immunohistochemistry as both a tumor-classification result and a hereditary-cancer triage result. Prompt hereditary-cancer referral is particularly consequential in a younger patient considering progestin-based conservative treatment because a germline MMR pathogenic variant, with associated colorectal, uterine, and ovarian cancer risk, may favor definitive surgery rather than fertility-sparing management. NatureNatureA clinically applicable molecular-based classification for endometrial cancers | British Journal of Cancer

Perform pelvic examination and pelvic ultrasonography as clinical-staging components. For suspected cervical stromal involvement or assessment of local uterine extent, MRI is the most reliable modality among MRI, transvaginal sonography, and diagnostic hysteroscopy for predicting cervical involvement. Oxford Academic+1Oxford AcademicESMO-ESGO-ESTRO Consensus Conference on...ScienceDirectReliability of diagnostic fluid hysteroscopy in the assessment of cervical invasion by endometrial carcinoma: A comparative study with transvaginal sonography and MRI - ScienceDirect

Use contrast-enhanced pelvic MRI, including diffusion-weighted sequences when relevant, to assess depth of myometrial invasion and local extension. Diffusion-weighted MRI is especially useful when gadolinium cannot be administered and when adenomyosis complicates assessment of myometrial invasion. ScienceDirectScienceDirectImaging and Staging of Endometrial Cancer - ScienceDirect

Use CT when the primary concern is advanced disease with extrauterine extension, lymphadenopathy, or distant metastases. Reserve PET/CT primarily for metastatic nodal or distant-disease evaluation when that result may change surgical or systemic management; PET/CT has limited value for initial evaluation of early-stage disease and cannot replace surgical staging. ScienceDirect+1ScienceDirectComparison of the validity of magnetic resonance imaging and positron emission tomography/computed tomography in the preoperative evaluation of patients with uterine corpus cancer - ScienceDirectScienceDirectImaging and Staging of Endometrial Cancer - ScienceDirect

For patients selected for primary surgical treatment, total hysterectomy with bilateral salpingo-oophorectomy and lymph-node assessment is standard care. Surgical pathology then supplies the definitive stage and the invasion, LVSI, histologic, and molecular features used for postoperative risk assessment. Wiley+1WileySentinel lymph node mapping in endometrial cancer ...ScienceDirectImproved Prognostic Stratification With 2023 International Federation of Gynecology and Obstetrics Staging in Endometrial Cancer Reflecting Poor Prognosis of Aggressive Histological Types and p53 Abnormality - ScienceDirect

Use sentinel lymph-node mapping as the nodal-assessment strategy when performed within an appropriate surgical-staging program. Its increasing adoption reflects the need to establish nodal status while avoiding a routine full lymphadenectomy approach in every patient. Wiley+1WileySentinel lymph node mapping in endometrial cancer ...WileyCA Cancer J Clin

Integrate molecular classification into postoperative risk assessment rather than using anatomic factors alone. The 2023 FIGO framework incorporates aggressive histologic types and p53 abnormality, and molecular classification is now incorporated into contemporary FIGO-based multidisciplinary decision-making. Wiley+2WileyFIGO staging of endometrial cancer: 2023 - BerekScienceDirectImproved Prognostic Stratification With 2023 International Federation of Gynecology and Obstetrics Staging in Endometrial Cancer Reflecting Poor Prognosis of Aggressive Histological Types and p53 Abnormality - ScienceDirectASCOImpact of Molecular Classification on Multidisciplinary ...

Fertility-sparing management is generally directed to stage IA, well-differentiated (grade 1) endometrioid endometrial carcinoma. Conservative protocols use oral or local progesterone therapy, but eligibility should be reassessed if molecular testing or hereditary evaluation identifies a germline MMR pathogenic variant. Wiley+1WileyFertility‐Sparing Approach in Patients with Endometrioid ...NatureA clinically applicable molecular-based classification for endometrial cancers | British Journal of Cancer

Before deferring hysterectomy, establish the extent of disease with pelvic examination and pelvic ultrasonography, and use MRI when local staging—including myometrial or cervical involvement—will determine whether conservative treatment remains appropriate. Oxford Academic+2Oxford AcademicESMO-ESGO-ESTRO Consensus Conference on...ScienceDirectImaging and Staging of Endometrial Cancer - ScienceDirectScienceDirectReliability of diagnostic fluid hysteroscopy in the assessment of cervical invasion by endometrial carcinoma: A comparative study with transvaginal sonography and MRI - ScienceDirect

Counsel that an abnormal MMR result has implications beyond tumor response: it prompts hereditary-cancer referral and may alter the balance between time-limited fertility preservation and definitive risk-reducing surgery. NatureNatureA clinically applicable molecular-based classification for endometrial cancers | British Journal of Cancer

In recurrent or metastatic endometrial cancer with measurable disease, expected median survival has historically been approximately 12 to 15 months, supporting early reassessment of disease extent and biomarker-directed treatment options at recurrence. WileyWileyCurrent recommendations and recent progress in endometrial ...

For patients with dMMR recurrent or advanced endometrial cancer previously treated with platinum, the PD-1 inhibitor dostarlimab demonstrated an objective response rate of 42.3% (95% CI, 31%-55%) in 104 patients. In the MMRp cohort, objective response was 13.4% (95% CI, 9.3%-20.1%) among 142 patients, making MMR status clinically discriminating when discussing expected immunotherapy activity. NatureNatureClinical outcome and biomarker assessments of a multi-centre phase II trial assessing niraparib with or without dostarlimab in recurrent endometrial carcinoma | Nature Communications

Do not select niraparib or niraparib plus dostarlimab as a presumed synergistic strategy based on the reported phase II study: the combination did not demonstrate synergistic activity, and homologous-recombination-repair gene status in circulating tumor DNA was not significantly associated with clinical outcome. NatureNatureClinical outcome and biomarker assessments of a multi-centre phase II trial assessing niraparib with or without dostarlimab in recurrent endometrial carcinoma | Nature Communications