The Evolving Management of Endometrial Cancer
The BCCA philosophy

Paul J. Hoskins, MD, MA, FRCPC and Anna V. Tinker, MD, FRCPC

The incidence of endometrial cancer in Canada is increasing as the population ages. With an estimated 4100 new cases in 2007, a woman’s lifetime risk is 2.4%.1 Endometrial cancer is the fourth most common cancer in women behind breast (22,300 new cases), lung (10,900) and colorectal (9400).1

 

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Top-line summary
Endometrial cancer, the fourth most common cancer in Canadian women, is often curable. About 20% of cases remain incurable, however, a rate that has changed very little in the last 10–15 years. The main treatment is surgery, with radiation therapy if there appears to be risk of local spread. Women at high risk of spread to distant sites are given chemotherapy to improve their survival odds. Examination of lymph nodes in the pelvic and para-aortic areas has traditionally been recommended, but recent evidence shows that this practice does not prolong survival. Surgical stage, tumour grade, histologic type and presence or absence of lymphovascular spread are the current means of evaluating risk, but they result in a substantial number of women receiving chemotherapy when they don’t actually need it. This article summarizes the policies and practices of the British Columbia Cancer Agency, and highlights areas where better treatments and criteria for determining risk of disease recurrence and metastatic spread are needed.
 
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