Surveillance for Stage III Mixed Uterine Cancer

Surveillance Schedule

The American College of Obstetricians and Gynecologists recommends following patients with stage III mixed uterine cancer every 3 months for the first 2 years, then every 6 months for years 3-5, and annually thereafter, with history, physical examination including speculum and pelvic exam at each visit, and imaging only as clinically indicated 1, 2
Comprehensive history focusing on symptoms of recurrence, such as vaginal bleeding, pelvic pain, abdominal distension, and weight loss, should be performed at each visit 3, 4, 5
Physical examination including speculum, bimanual pelvic, and rectovaginal examination should be performed at each visit, as 26-50% of recurrences occur in the pelvis 1, 2

No routine imaging, such as CT, MRI, PET-CT, or chest X-ray, is recommended in asymptomatic patients 1, 2
CA-125 has insufficient data to support routine use in surveillance 1, 2
Pap smear/cytology is not indicated for surveillance 1, 2
CT and/or PET-CT scan should be obtained when clinical examination or symptoms suggest recurrence 1, 2

41-83% of recurrences are detected by symptoms alone, making patient education about warning signs critical 2
Physical examination detects 35-68% of recurrences 2
Most recurrences in endometrial cancer occur within the first 3 years, justifying the more intensive early surveillance 3, 4, 5
Patients with endometrial cancer have an increased risk of secondary malignancies, such as breast, ovary, and colon cancer, and should be screened for these during surveillance visits 3, 4, 5
Consider genetic counseling/testing for patients under 50 years old or those with significant family history of endometrial/colorectal cancer to evaluate for Lynch syndrome 6