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6. Follow-up

Objectives for follow-up for Endometrial Cancer

  1. Early recognition and prompt management of treatment-related complications
  2. Early detection of persistent or recurrent disease
  3. Collection of meaningful data regarding the efficacy of existing treatment policies and their complications so that any appropriate modifications can be instituted
  4. Risk factors for endometrial cancer are similar to those for other cancers such as breast and colorectal. Women who have endometrial cancer are at increased risk for these cancers and should be advised to undergo regular screening

In all situations outlined below, history and physical exam, including pelvirectal examination, are recommended. Patients do not need routine bloodwork, pap smear, or imaging, unless indicated by symptoms or signs on examination1,2.

I. Patients in whom no adjuvant treatment is recommended

These patients are at low risk of recurrence (<5%), which is most likely to occur within the first 2 years after primary treatment. The most likely site of recurrence is the vaginal vault, therefore these patients need to be counselled about vaginal bleeding. Their follow-up care can be provided by their referring physician.

Years 1 through 5: every 6 months

Year 5+: annually

II. Patients treated with adjuvant vaginal vault radiation alone

These patients are still at low risk of recurrence (5-10%), which is most likely to occur within the first 2-3 years after primary treatment. They can recur in the pelvis/vault, but some will recur distantly. These patients need to be counselled about vaginal bleeding, pelvic pain, bloating, increased abdominal girth. Their follow-up care can be provided by their referring physician. 

Years 1 2: every 3-6 months

Years 3-5: every 6 months

Year 5+: annually

III. Patients treated with adjuvant pelvic radiation +/- chemotherapy

These patients are at high risk of recurrence, which may be distant or locoregional. Their recurrences are also most likely to occur within the first 2-3 years after primary treatment. These patients will typically be seen at least once following completion of radiotherapy by the radiation oncologist at BC Cancer to review/manage side-effects of treatment. Further follow-up care can then be provided by the referring physician. 

Years 1-2: every 3-6 months

Years 3-5: every 6 months

Year 5: annually

IV. Patients who have been recommended adjuvant treatment but have declined

These patients should be followed more frequently as they have the potential for salvage treatment. Their follow-up care can be provided by their referring physician. 

Years 1 and 2: every 3 - 4 months

Years 3 - 5: every 6 months

Year 5+: annually

References

  1. Colombo N et al. Endometrial cancer: EMSO clinical practice guidelines for diagnosis, treatment, and follow-up. Ann Oncol 2013;24(suppl6):vi33-vi38
  2. Canadian Cancer Society 2015 http://www.cancer.ca/en/cancer-information/cancer-type/uterine/treatment/follow-up

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