Management of Grade 1 Endometrial Cancer

Primary Surgical Management

The European Society for Medical Oncology recommends that all patients with grade 1 endometrial cancer should undergo comprehensive surgical staging as the cornerstone of treatment, which must include total hysterectomy with bilateral salpingo-oophorectomy, peritoneal fluid or washings for cytology, thorough exploration of the abdominal cavity, pelvic and para-aortic nodal areas, and pelvic and para-aortic lymph node assessment 1, 2, 3
The National Comprehensive Cancer Network recommends that the pathologic evaluation must document depth of myometrial invasion, cervical involvement, tumor size and location, lymphovascular space invasion, and nodal status when resected 4

The European Society for Medical Oncology recommends that grade 1 endometrial cancer patients are stratified into risk categories that determine adjuvant therapy, with low-risk patients (stage IA/IB, grade 1, endometrioid histology) requiring no adjuvant therapy after surgery 1, 2
The National Comprehensive Cancer Network recommends that patients with intermediate-risk disease (age ≥60 years, deeper myometrial invasion, or lymphovascular space invasion) should receive vaginal brachytherapy alone as the preferred adjuvant treatment 5, 6

The National Comprehensive Cancer Network recommends that fertility-sparing treatment with high-dose progestins may be considered in highly selected young patients who meet specific criteria, including well-differentiated (grade 1) endometrioid adenocarcinoma, disease limited to the endometrium, no myometrial invasion, and absence of suspicious or metastatic disease on imaging 4

The European Society for Medical Oncology recommends that optimal surgical debulking remains the initial approach for advanced stage grade 1 tumors, followed by combination chemotherapy with cisplatin and doxorubicin or carboplatin and paclitaxel, which significantly improves progression-free and overall survival compared to radiation alone 1, 2, 5