Endometrial cancer: an update on diagnosis, treatment and the role of molecular profiling

Abstract

The incidence of endometrial cancer in the UK has risen steeply since the 1990s. Survival has improved significantly over several decades but outcomes for 25% of women remain poor. Surgery is the initial treatment approach in most cases. Sentinel node surgery has largely replaced systematic lymphadenectomy for surgical staging in apparent early-stage disease. Radiotherapy and chemotherapy are used to reduce recurrence, and for upfront primary treatment in selected cases. Different endometrial cancer sub-types have different aetiologies, histological and molecular characteristics and prognoses. Molecular classification of tumours is now indicated in all patients treated for endometrial cancer. Molecular characterization has important implications for treatment options, both at initial presentation and any subsequent recurrence, including access to new immunotherapy treatments. In addition, “mainstreaming” of genetic testing in those at risk of Lynch syndrome, will improve identification of at-risk families and help prevent future endometrial, ovarian and bowel cancers.