A Contemporary Approach to Pathologic Diagnosis of Endometrial Cancer

Role of pathologic variables in management of endometrial cancer There are four major decisions in the management of a patient with a biopsy diagnosis of endometrial cancer. Pathologic tumor variables, along with patient age and clinical/radiologic staging, play a central role in these decisions. In general, surgeons broadly categorize endometrial cancer into low versus high risk behavior in order to navigate these management options. High risk behavior is defined as a cancer that is likely to present at advanced stage, to be chemo-resistant, to recur locally (vaginal cuff, pelvis), to metastasize, or to progress to death. High risk cancer can be defined by histologic sub-type (all grade 3 cancers) and by higher stages (involvement of outer myometrium, lymphovascular spaces, cervix, adnexa, or extra-pelvic sites). Low risk cancer includes grade 1 endometrioid cancer confined to endometrium. The behavior of grade 1 and grade 2 endometrioid cancers with myometrial invasion or LVI is difficult to estimate and therefore these scenarios constitute an intermediate risk zone. To demonstrate the specific role of pathology, the general concepts of management currently used at UCSF are discussed below (kindly summarized by my colleague Lee-may Chen MD, Gynecologic Oncology Division).