An Evaluation of Endometrial Cancer Guidelines for Optimal Patient Care

Comparative research published in Cancers reviews guidelines on the management of endometrial cancer, providing valuable information for clinicians, and highlighting the importance of consistent protocols due to the prevalence of the disease in postmenopausal women.

Molecular classification has become an important tool for evaluating recurrence risk and survival probability for endometrial cancer. Major guidelines have been developed by national and international medical societies to optimize therapeutic protocols for the management of endometrial cancer. The most recent guidelines for managing endometrial cancer, based on the International Federation of Gynecology and Obstetrics (FIGO) classification, were reviewed from 6 sources: 

• The National Comprehensive Cancer Network (NCCN 2023);
• The consensus among the European Society of Gynecological Oncology (ESGO);
• European Society for Radiotherapy and Oncology (ESTRO);
• European Society of Pathology (ESP) (2020);
• The Cancer Council of Australia (CCA 2020);
• The European Society for Medical Oncology (ESMO) (2022);
• The American College of Obstetricians and Gynecologists (ACOG); and
• The British Gynecological Cancer Society (BGCS 2022). 

Recommendations for preoperative management, surgical procedures, and adjuvant therapy were evaluated. Different guidelines recommend various approaches to diagnostic hematoxylin and eosin (H&E) staining, imaging, and prognostic factors for stratifying low-, intermediate-, and high-risk patients.

Surgical treatment for endometrial cancer typically includes total hysterectomy with bilateral salpingo-oophorectomy (TAH/BSO) and lymph node evaluation, with the option of ovarian preservation in premenopausal patients with low-risk disease to potentially improve survival rates. Minimally invasive surgical approaches, such as laparoscopic or robotic procedures, are recommended for patients with disease confined to the endometrium to reduce postoperative complications and hospitalization time without compromising outcomes.

In advanced-stage cases, peritoneal biopsy and lymph node assessment are important for therapeutic decisions, with sentinel lymph node biopsy emerging as an alternative to traditional lymph node resection. The presence of macro- and micro-metastases in lymph nodes indicates a worse prognosis and may require more aggressive treatment options, such as lymphadenectomy. Recommendations from various medical societies highlight the importance of individualized treatment based on disease characteristics and patient health status.

Fertility preservation treatment is recommended for select patients with low-grade tumors who desire to retain their reproductive ability, according to guidelines from ACOG, NCCN, ESGO-ESTRO-ESP, ESMO, and BGCS. The ESGO-ESTRO-ESP guidelines stress the importance of molecular categorization for a personalized approach, whereas NCCN does not prioritize this aspect. Adjuvant therapy, including chemotherapy, radiotherapy, and hormonal treatment, plays a crucial role in improving treatment outcomes and quality of life for endometrial cancer patients; however, there are discrepancies in recommendations among guidelines based on the patient's risk group and molecular profile of the tumor.

The guidelines from ESGO-ESTRO-ESP and ESMO emphasize the importance of molecular classification in decision-making for treatment strategies, while NCCN and ACOG apply more traditional criteria. Discrepancies also exist in surgical staging recommendations, with differing opinions on the performance of lymphadenectomy between the guidelines. Finally, variations are evident in adjuvant therapy approaches: ESGO-ESTRO-ESP and ESMO advocate for personalized treatments based on molecular profiling, whereas NCCN and ACOG remain more conservative with traditional staging methods.

“Different guidelines often bring different perspectives, reflecting the latest research findings and clinical experiences,” researchers said. “This diversity ensures that clinicians should be well informed about various aspects of endometrial cancer management, ranging from risk assessment and staging to treatment options and postoperative care. In addition, the combination of guidelines facilitates an individualized approach to patient management. By intersecting various guidelines, especially in settings with no official national guidance, clinicians may tailor their decisions to each patient’s unique individual characteristics, such as age, comorbidities, and tumor histology; this approach could contribute to the most appropriate patient care, tailored to their needs.”

Reference
Kopatsaris S, Tsakiridis I, Kapetanios G, et al. Management of endometrial cancer: A comparative review of guidelines. Cancers. 2024;16(21):3582. doi:10.3390/cancers16213582