Surveillance procedures for patients treated for endometrial cancer: a review of the literature.
OBJECTIVE
The aim of this review was to analyze the role of follow-up in patients treated for endometrial cancer and to provide some compelling issues that may contribute to improve daily practice while waiting for evidence-based guidelines.


METHODS
A literature search has been conducted in MEDLINE database using key words "endometrial neoplasms" and "follow up".


RESULTS
Endometrial cancer represents the most common gynecologic malignancy after breast cancer. The overall recurrence rate is 13% and correlates with prognostic factors of the primary tumor. The anatomic sites of endometrial cancer relapse are mostly equivalently distributed between local (pelvic) and distant (abdominal and chest). Most endometrial cancer recurrences are symptomatic, even if vaginal vault relapses represent a particular setting of a more frequently asymptomatic disease. Most of endometrial cancer recurrences occur within 3 years since diagnosis of primary tumor. Long-term surveillance programs are mainly addressed to the early detection of recurrence, the rationale of follow-up being that an earlier diagnosis of relapse correlates with lower morbidity and mortality rates. Adjunctive objectives of routine follow-up are identification of treatment complications and detection of possible second tumors associated with endometrial cancer.


CONCLUSIONS
No rationale (examination sensitivity/sensibility, cost-effectiveness, or patient's survival benefit) is available today for any particular follow-up protocol; follow-up procedures should probably be tailored according to different prognostic factors; only physical examination, including pelvic-rectal examination, showed some utility in detecting recurrence. In this uncertain setting, follow-up interval should be defined with the consideration of the patient's will.
Sartori
Enrico
E
Department of Gynecology and Obstetrics, University of Brescia, Brescia, Italy.
Pasinetti
Brunella
B
Chiudinelli
Francesca
F
Gadducci
Angiolo
A
Landoni
Fabio
F
Maggino
Tiziano
T
Piovano
Elisa
E
Zola
Paolo
P
D014408:Biomarkers, Tumor / Q000032:analysis; D001707:Biopsy, Needle; D018394:CA-125 Antigen / Q000032:analysis; D003131:Combined Modality Therapy; D055088:Early Detection of Cancer; D016889:Endometrial Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007150:Immunohistochemistry; D008991:Monitoring, Physiologic / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D009367:Neoplasm Staging; D010808:Physical Examination / Q000379:methods; D011379:Prognosis; D018570:Risk Assessment; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014481:United States
D014408:Biomarkers, Tumor; D018394:CA-125 Antigen