Introduction: Uterine cancer is the most common gynecologic malignancy, although fortunately, 75% of women present with early-stage disease. A major area of controversy regarding the management of the disease concerns postoperative therapy for both women with early- and advanced-stage endometrial carcinoma. Here, we review landmark evidence that can help guide clinical decision-making in the treatment of women diagnosed with endometrial cancer.
Areas covered: In this review, we present the latest data driving decisions for both surgical management and postoperative therapy for women with endometrial carcinoma. Areas discussed include surgical staging, with a specific discussion on the role of sentinel lymph node mapping, and postoperative therapy, ranging from the data supporting observation for women with early-stage, low-risk disease to combination therapy for women with advanced disease. Less common histologies, such as serous and clear cell carcinoma, as well as carcinosarcoma, will also be covered. Furthermore, a section of the paper is dedicated to the current state of fertility-sparing surgery.
Expert opinion: We suggest several approaches for deciding on adjuvant therapy, based on stage and histology, after comprehensive surgical staging. The role that endometrial cancer molecular subtypes will play on postoperative therapy remains to be fully investigated.
Keywords: Endometrial cancer; adjuvant therapy; carcinosarcoma; clear cell; endometrioid; fertility-sparing treatment; sentinel lymph node mapping; serous; surgical staging.