Establish intent of treatment

• Curative
• Anti-cancer therapy to improve quality of life and/or longevity without expectation of cure
• Symptom palliation

Refer to the endometrial optimal care pathway for recommendations for screening for Lynch syndrome.

Surgery

Surgery is the primary treatment for endometrial cancer. The type of surgery offered will depend on several factors such as the extent and grade of disease, the patient’s age, medical comorbidities, performance status and desire to retain fertility.

Radiation therapy

For patients with adverse risk factors, adjuvant radiation may be offered.

In selected cases, where surgery is inappropriate, radiation therapy may be offered as part of primary treatment or for symptomatic relief and palliation of metastatic or recurrent disease.

Systemic therapy

A number of patients may benefit from systemic therapy:

• patients with adverse risk factors (systemic therapy may be offered in conjunction with adjuvant radiotherapy to improve local control and, in selected cases, survival)
• as primary treatment, where the patient is not suitable for surgery
• to manage recurrent/metastatic or residual disease following surgery.

Hormonal therapy

Hormonal therapy may be appropriate for: fertility preservation in young patients; intrauterine and/or high-dose oral progestins in well-differentiated early-stage disease for patients who are unfit for surgery; or for symptom management in patients with recurrent/metastatic disease.

Palliative care

Early referral to palliative care can improve quality of life and in some cases survival. Referral should be based on need, not prognosis. For more, visit the Palliative Care Australia website.

Communication

The lead clinician and team’s responsibilities include:

• discussing treatment options with the patient and/or carer including the intent of treatment as well as risks and benefits
• discussing advance care planning with the patient and/or carer where appropriate
• communicating the treatment plan to the patient’s GP
• helping patients to find appropriate support for exercise programs where appropriate to improve treatment outcomes.

Checklist

Timeframe

Surgery should occur within 4 weeks of the MDM, provided the patient is medically fit.

Radiation therapy or systemic therapy should begin within 6 weeks of the MDM if used for primary treatment and within 8 weeks after surgery if being used as adjuvant treatment.