Treatment for Low-Grade Endometrial Adenocarcinoma

Surgical Management

The American College of Obstetricians and Gynecologists recommends total hysterectomy with bilateral salpingo-oophorectomy as the cornerstone of treatment for low-grade endometrial adenocarcinoma, with peritoneal fluid or washings obtained during the procedure, and thorough exploration of the abdominal cavity and pelvic areas performed 1, 2
For low-risk endometrial carcinoma, lymphadenectomy is not recommended as it provides no survival benefit, with a low risk of lymph node involvement in low-grade, superficially invasive tumors 3
Endometrial carcinoma is surgically staged according to the FIGO system, with low-risk disease defined as stage Ia/Ib, grade 1 or 2, with endometrioid histology 1, 2

For low-risk endometrial adenocarcinoma, no adjuvant therapy is recommended, with a 5-year disease-free survival rate of approximately 93% for surgically staged patients with endometrial carcinoma confined to the uterine corpus 4, 5
For intermediate-risk disease, adjuvant pelvic radiotherapy reduces the risk of pelvic/vaginal relapses but has no impact on overall survival, with patients having two of three major risk factors benefiting from adjuvant pelvic radiotherapy 4, 5
The adjuvant administration of progestational agents in low-stage endometrial cancer does not increase survival and is not recommended, although progestational agents are active in steroid receptor-positive tumors in advanced or recurrent disease 4, 5, 6

For young women with grade 1 endometrial adenocarcinoma who wish to preserve fertility, conservative management with progestin therapy may be considered, with close follow-up essential as recurrent disease may require definitive surgical management 7
Follow-up evaluations with history, physical and gynecological examination are recommended every 3-4 months for the first 3 years, with follow-up intervals of 6 months during the fourth and fifth years, and annually thereafter 8