Joint SOGC-GOC-SCC Clinical Practice Guideline - Epidemiology and Investigations for Suspected Endometrial Cancer

Blogger's Note: see article for levels of evidence

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 No. 291, April 2013 (Replaces no. 51, November 1996)

Abstract
Objective: To review the evidence relating to the epidemiology ofendometrial cancer and its diagnostic workups.

Recommendations
1. A complete focused history should be taken and a physical
examination carried out in patients with suspected endometrial
cancer. Attention should be paid to predisposing factors for excess
estrogen stimulation of the endometrium such as long history of
anovulation, obesity, menstrual irregularity, or long-term use of
unopposed estrogen or tamoxifen. Patients with a strong family
history of endometrial, ovarian, and colorectal cancers might have
inherited Lynch syndrome (hereditary non-polyposis colorectal
cancer syndrome) that increases their lifetime risk of developing
endometrial cancer. Genetic counselling and testing can be used
to individualize risk-management interventions including screening
strategies and treatment options. (III-B)
2. Endometrial cancer should be ruled out in perimenopausal and
postmenopausal patients with abnormal vaginal bleeding. (II-1A)
3. Depending on access, histologic endometrial evaluation
and transvaginal ultrasound are the preferred initial
diagnostic investigations for patients with suspected
endometrial cancer. (II-1B)
4. Histologic evaluation of the endometrium should be done in all
patients in whom endometrial cancer is suspected. (II-1A)
5. Hysteroscopic examination should be considered in patients with
persistent uterine bleeding with benign endometrial sampling or
insufficient endometrial sampling after ultrasound. (II-2B)
6. Formal review of the histopathology should be considered in
patients with high grade tumours or rare histologic types such as
serous, clear cell, or mucinous types. (III-B)
7. Additional tumour markers, CT scan, and MRI scan should not be
used routinely. (III-D)