Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

Treatment of low-risk endometrial cancer

Steven C Plaxe, MD
Arno J Mundt, MD
Section Editor
Barbara Goff, MD
Deputy Editors
Sadhna R Vora, MD
Sandy J Falk, MD, FACOG


Endometrial cancer is cancer of the uterine lining. Surgery is the standard treatment for women with low-risk endometrial cancer, and the prognosis is usually excellent. Adjuvant therapy is most often not recommended with low-risk disease.

This review will focus on the options for adjuvant treatment in endometrial cancer and will explain why it is not recommended for women with low-risk disease. The treatment of intermediate- and high-risk endometrial cancers is discussed separately.

(See "Approach to adjuvant treatment of endometrial cancer".)

(See "Adjuvant treatment of intermediate-risk endometrial cancer".)

(See "Adjuvant treatment of high-risk endometrial cancers".)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jan 2017. | This topic last updated: Thu Oct 22 00:00:00 GMT+00:00 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Madom LM, Brown AK, Lui F, et al. Lower uterine segment involvement as a predictor for lymph node spread in endometrial carcinoma. Gynecol Oncol 2007; 107:75.
  2. Kizer NT, Gao F, Guntupalli S, et al. Lower uterine segment involvement is associated with poor outcomes in early-stage endometrioid endometrial carcinoma. Ann Surg Oncol 2011; 18:1419.
  3. Brown AK, Madom L, Moore R, et al. The prognostic significance of lower uterine segment involvement in surgically staged endometrial cancer patients with negative nodes. Gynecol Oncol 2007; 105:55.
  4. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelnes): Uterine neoplasms. Version 2.2012. http://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf (Accessed on December 09, 2011).
  5. 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; 40:55.
  6. Eifel PJ, Ross J, Hendrickson M, et al. Adenocarcinoma of the endometrium. Analysis of 256 cases with disease limited to the uterine corpus: treatment comparisons. Cancer 1983; 52:1026.
  7. Orr JW Jr, Holimon JL, Orr PF. Stage I corpus cancer: is teletherapy necessary? Am J Obstet Gynecol 1997; 176:777.
  8. Straughn JM Jr, Huh WK, Kelly FJ, et al. Conservative management of stage I endometrial carcinoma after surgical staging. Gynecol Oncol 2002; 84:194.
  9. Keys HM, Roberts JA, Brunetto VL, et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol 2004; 92:744.
  10. Kong A, Johnson N, Kitchener HC, Lawrie TA. Adjuvant radiotherapy for stage I endometrial cancer. Cochrane Database Syst Rev 2012; :CD003916.
  11. Onsrud M, Cvancarova M, Hellebust TP, et al. Long-term outcomes after pelvic radiation for early-stage endometrial cancer. J Clin Oncol 2013; 31:3951.
  12. Sorbe B, Nordström B, Mäenpää J, et al. Intravaginal brachytherapy in FIGO stage I low-risk endometrial cancer: a controlled randomized study. Int J Gynecol Cancer 2009; 19:873.
  13. Martin-Hirsch PP, Bryant A, Keep SL, et al. Adjuvant progestagens for endometrial cancer. Cochrane Database Syst Rev 2011; :CD001040.
  14. Eltabbakh GH, Shamonki J, Mount SL. Surgical stage, final grade, and survival of women with endometrial carcinoma whose preoperative endometrial biopsy shows well-differentiated tumors. Gynecol Oncol 2005; 99:309.
  15. Leitao MM Jr, Kehoe S, Barakat RR, et al. Comparison of D&C and office endometrial biopsy accuracy in patients with FIGO grade 1 endometrial adenocarcinoma. Gynecol Oncol 2009; 113:105.
  16. Montz FJ, Bristow RE, Bovicelli A, et al. Intrauterine progesterone treatment of early endometrial cancer. Am J Obstet Gynecol 2002; 186:651.
  17. Dhar KK, NeedhiRajan T, Koslowski M, Woolas RP. Is levonorgestrel intrauterine system effective for treatment of early endometrial cancer? Report of four cases and review of the literature. Gynecol Oncol 2005; 97:924.
  18. Jadoul P, Donnez J. Conservative treatment may be beneficial for young women with atypical endometrial hyperplasia or endometrial adenocarcinoma. Fertil Steril 2003; 80:1315.
  19. Kinkel K, Kaji Y, Yu KK, et al. Radiologic staging in patients with endometrial cancer: a meta-analysis. Radiology 1999; 212:711.
  20. Gunderson CC, Fader AN, Carson KA, Bristow RE. Oncologic and reproductive outcomes with progestin therapy in women with endometrial hyperplasia and grade 1 adenocarcinoma: a systematic review. Gynecol Oncol 2012; 125:477.
  21. Gallos ID, Yap J, Rajkhowa M, et al. Regression, relapse, and live birth rates with fertility-sparing therapy for endometrial cancer and atypical complex endometrial hyperplasia: a systematic review and metaanalysis. Am J Obstet Gynecol 2012; 207:266.e1.
  22. Kalogera E, Dowdy SC, Bakkum-Gamez JN. Preserving fertility in young patients with endometrial cancer: current perspectives. Int J Womens Health 2014; 6:691.
  23. Kudesia R, Singer T, Caputo TA, et al. Reproductive and oncologic outcomes after progestin therapy for endometrial complex atypical hyperplasia or carcinoma. Am J Obstet Gynecol 2014; 210:255.e1.
  24. Mentrikoski MJ, Shah AA, Hanley KZ, Atkins KA. Assessing endometrial hyperplasia and carcinoma treated with progestin therapy. Am J Clin Pathol 2012; 138:524.
  25. Wheeler DT, Bristow RE, Kurman RJ. Histologic alterations in endometrial hyperplasia and well-differentiated carcinoma treated with progestins. Am J Surg Pathol 2007; 31:988.
  26. Kaku T, Yoshikawa H, Tsuda H, et al. Conservative therapy for adenocarcinoma and atypical endometrial hyperplasia of the endometrium in young women: central pathologic review and treatment outcome. Cancer Lett 2001; 167:39.
  27. Ushijima K, Yahata H, Yoshikawa H, et al. Multicenter phase II study of fertility-sparing treatment with medroxyprogesterone acetate for endometrial carcinoma and atypical hyperplasia in young women. J Clin Oncol 2007; 25:2798.
  28. Mazzon I, Corrado G, Masciullo V, et al. Conservative surgical management of stage IA endometrial carcinoma for fertility preservation. Fertil Steril 2010; 93:1286.
  29. Eftekhar Z, Izadi-Mood N, Yarandi F, et al. Efficacy of megestrol acetate (megace) in the treatment of patients with early endometrial adenocarcinoma: our experiences with 21 patients. Int J Gynecol Cancer 2009; 19:249.
  30. Park JY, Kim DY, Kim JH, et al. Long-term oncologic outcomes after fertility-sparing management using oral progestin for young women with endometrial cancer (KGOG 2002). Eur J Cancer 2013; 49:868.
  31. Bakkum-Gamez JN, Kalogera E, Keeney GL, et al.. Conservative management of atypical hyperplasia and grade I endometrial carcinoma: Review of the literature and presentation of series. J Gynecol Surg 2012; 28:262.
  32. Hubbs JL, Saig RM, Abaid LN, et al. Systemic and local hormone therapy for endometrial hyperplasia and early adenocarcinoma. Obstet Gynecol 2013; 121:1172.
  33. Abu Hashim H, Ghayaty E, El Rakhawy M. Levonorgestrel-releasing intrauterine system vs oral progestins for non-atypical endometrial hyperplasia: a systematic review and metaanalysis of randomized trials. Am J Obstet Gynecol 2015; 213:469.
  34. Fung-Kee-Fung M, Dodge J, Elit L, et al. Follow-up after primary therapy for endometrial cancer: a systematic review. Gynecol Oncol 2006; 101:520.
  35. Folsom AR, Anderson KE, Sweeney C, Jacobs DR Jr. Diabetes as a risk factor for death following endometrial cancer. Gynecol Oncol 2004; 94:740.
  36. Ward KK, Shah NR, Saenz CC, et al. Cardiovascular disease is the leading cause of death among endometrial cancer patients. Gynecol Oncol 2012; 126:176.
  37. Bjørge T, Stocks T, Lukanova A, et al. Metabolic syndrome and endometrial carcinoma. Am J Epidemiol 2010; 171:892.
  38. Rosato V, Zucchetto A, Bosetti C, et al. Metabolic syndrome and endometrial cancer risk. Ann Oncol 2011; 22:884.