The grades of evidence (I-III) and levels of recommendation (A-C) are defined at the end of the "Major Recommendations" field.
The following recommendations are based on limited or inconsistent scientific evidence (Level B):
- Most women with endometrial cancer should undergo systematic surgical staging, including pelvic washings, bilateral pelvic and paraaortic lymphadenectomy, and complete resection of all disease. Exceptions to this include young or perimenopausal women with grade 1 endometrioid adenocarcinoma associated with atypical endometrial hyperplasia and those at increased risk of mortality secondary to comorbidities.
- Women with atypical endometrial hyperplasia and endometrial cancer who desire to maintain their fertility may be treated with progestin therapy. Following therapy they should undergo serial complete intrauterine evaluation approximately every 3 months to document response. Hysterectomy should be recommended for women who do not desire future fertility.
- Patients with surgical stage I disease may be counseled that postoperative radiation therapy can reduce the risk of local recurrence, but the cost and toxicity should be balanced with the evidence that it does not improve survival or reduce distant metastasis.
- For those women who have not received radiation therapy, pelvic examinations every 3 to 4 months for 2 to 3 years, then twice yearly following surgical treatment of endometrial cancer are recommended for detection and treatment of recurrent disease.
The following recommendations are based primarily on consensus and expert opinion (Level C):
- Women who cannot undergo systematic surgical staging because of comorbidities may be candidates for vaginal hysterectomy.
- Only a physical examination and a chest radiograph are required for preoperative staging of the usual (type I endometrioid grade 1) histology, clinical stage I patient. All other preoperative testing should be directed toward optimizing the surgical outcome.
Definitions:
Grades of Evidence
I: Evidence obtained from at least one properly designed randomized controlled trial.
II-1: Evidence obtained from well-designed controlled trials without randomization.
II-2: Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.
II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments also could be regarded as this type of evidence.
III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
Levels of Recommendations
Level A — Recommendations are based on good and consistent scientific evidence.
Level B — Recommendations are based on limited or inconsistent scientific evidence.
Level C — Recommendations are based primarily on consensus and expert opinion.
