The first joint European Society for Medical Oncology
(ESMO), European SocieTy for Radiotherapy & Oncology (ESTRO) and European
Society of Gynaecological Oncology (ESGO) consensus conference on endometrial
cancer was held on 11–13 December 2014 in Milan,
Italy.
The multidisciplinary panel consists of 40 leading experts
on endometrial cancer.
The experts were asked to prepare 3 clinically relevant
questions on four basic areas related to the cancer: prevention and screening,
surgery, adjuvant treatment and advanced and recurrent disease. They developed
these extremely relevant guidelines after going through the literature
methodically.
There was more than 90% agreement was reached for all the
guidelines except one for or performance of staging lymphadenectomy in patients
who have deeply invasive grade 3 cancers( agreement 73%).
These guidelines provide an invaluable framework for
clinical decision making especially in an area fraught with uncertainties.
These guidelines were published in an article by Colombo N et al in January issue of Annals of Oncology.
For each of four basic subject areas, three relevant clinical
questions were identified, giving a total of 12 categories on which the
guidelines were developed.
The first question is: Which surveillance should be used for asymptomatic women?
Women with average risk for endometrial cancer
Recommendation 1.1: There is no evidence for
endometrial cancer screening in the general population. Evidence: II, strength of
recommendation :A.
Women at increased risk for endometrial cancer
Recommendation 1.2: Unopposed oestrogen treatment
should not be started or should be discontinued in women with a uterus in
situ? Evidence: III, strength of recommendation A.
Recommendation 1.3: Routine surveillance in
asymptomatic women with obesity, PCOS, diabetes mellitus, infertility,
nulliparity or late menopause is not recommended. Evidence: III, strength of
recommendation: B.
Recommendation 1.4: For women with adult granulosa
cell tumour, if hysterectomy has not been performed, endometrial sampling is
recommended. If this shows no evidence of (pre)malignancy, no further screening
for endometrial malignancies is required. Evidence: IV, strength of recommendation:B.
Recommendation 1.5: In patients with epithelial
ovarian cancer undergoing fertility-sparing treatment, endometrial sampling is
recommended at the time of diagnosis. Evidence: IV, strength of recommendation:
B.
Recommendation 1.6: Routine screening for
endometrial cancer in asymptomatic tamoxifen users is not recommended. Evidence:
III, strength of recommendation: B.
Women with high risk for endometrial cancer
Recommendation 1.7: Surveillance of the endometrium
by gynaecological examination, transvaginal ultrasound and aspiration biopsy
starting from the age of 35 years (annually until hysterectomy) should be
offered to all Lynch Syndrome (LS) mutation carriers
Evidence: IV,Strength of recommendation: B.
Recommendation 1.8: Prophylactic surgery
(hysterectomy and bilateral salpingo-oophorectomy), preferably using a
minimally invasive approach, should be discussed at the age of 40 as an option
for Lynch Syndrome(LS) mutation carriers
to prevent endometrial and ovarian cancer. All pros and cons of prophylactic
surgery must be discussed
Level of evidence: IV,Strength of recommendation: B.
To be continued------------
References:
Colombo N,Creutzberg CL, Amant F et al. ESMO-ESGO-ESTRO consensus conference on endometrial cancer: diagnosis, treatment and follow-up. Ann Oncol 2016; 27: 16–41.
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