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Endometrial carcinoma: Pretreatment evaluation, staging, and surgical treatment

Steven C Plaxe, MD
Section Editor
Barbara Goff, MD
Deputy Editor
Sandy J Falk, MD, FACOG


Uterine cancer (picture 1) is the most common gynecologic malignancy in the United States; annually there are approximately 46,470 new cases and 8120 deaths from the disease [1]. Women have a 2.5 percent lifetime risk of developing endometrial carcinoma, which accounts for 6 percent of all cancers in women. Fortunately, most cases are diagnosed at an early stage when surgery alone may be adequate for cure. Five-year survival rates for localized, regional, and metastatic disease are 96, 67, and 17 percent, respectively.

Preoperative evaluation, staging, and posttreatment surveillance for endometrial carcinoma will be reviewed here. Risk factors, clinical features, diagnosis, and histopathology, treatment with chemotherapy or radiation, and uterine sarcoma are discussed separately. (See "Endometrial carcinoma: Epidemiology and risk factors" and "Treatment of low-risk endometrial cancer" and "Treatment of recurrent or metastatic endometrial cancer" and "Uterine sarcoma: Classification, clinical manifestations, and diagnosis" and "Treatment and prognosis of uterine leiomyosarcoma".)


Prior to treatment, a complete pelvic and general physical examination should be performed, with particular attention to the size and mobility of the uterus and the presence of extrauterine masses or ascites; potential sites of nodal metastases should also be examined (eg, supraclavicular nodes) [2]. Laboratory evaluation or imaging studies should be selected as appropriate for the planned treatment (eg, major surgery, chemotherapy, radiation), patient comorbidities, and suspicion of metastases. Cervical cancer screening should be performed as appropriate. (See "Preoperative medical evaluation of the adult healthy patient" and "Preoperative evaluation and management of patients with cancer" and "Screening for cervical cancer".)

Preoperative issues related to endometrial carcinoma staging are discussed in this section. Diagnosis of endometrial carcinoma is discussed in detail separately.

Assessment for hereditary cancer syndromes — Lynch syndrome (hereditary nonpolyposis colon cancer) is associated with a greatly increased risk of endometrial carcinoma, as well as colon and ovarian cancer and other Lynch-associated malignancies. Synchronous tumors discovered intraoperatively are common in these women. Synchronous tumors are simultaneously diagnosed primary tumors involving two different organs. These tumors do not represent a metastasis from one organ to the other. Women with endometrial carcinoma who have a family history suggestive of Lynch syndrome should be referred for genetic counseling and testing and also have testing of their tumor specimen for the mismatch repair proteins which characterize this syndrome. (See "Lynch syndrome (hereditary nonpolyposis colorectal cancer): Clinical manifestations and diagnosis" and 'Testing of tumor specimen for mismatch repair deficiency' below.)


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