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Endometrial Cancer

Cancer Care Alberta

The evidence-based recommendations described below outline the standard follow-up procedures for endometrial cancer surveillance and are intended to assist you in providing optimal cancer follow-up care for your patient; these recommendations are not intended to be a substitute for clinical judgement.

Topics

Surveillance Activities & Timelines|Red Flags|Referrals for Recurrence|Complications & Late Effects of Treatment|Specific Concerns for Patients|General Support for Healthy Living

Quick Reference

Surveillance Activities & Timelines

Once a patient has been discharged from Cancer Care Alberta, their primary care provider is asked to organize the following surveillance activities:

  • General assessment including complete history, elicitation of symptoms, speculum exam, and pelvic-rectal exam. The frequency of surveillance appointments depends on the stage of the cancer and the patient’s individual situation.
  • Please review the detailed progress notes for your patient’s stage and the exact schedule you should follow:
 
Year Since Completed Treatment 1-3 4-5
Stage IA or IB, Grade 1 or 2 Every 6 months Annually
Stage IA or IB, Grade 3 Every 4 months Every 6 months
Stage II or Higher Every 4 months Every 6 months
 
  • Papanicolaou testing is not useful for detecting recurrences and is not recommended. Other routine tests and imaging are not recommended.

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Red Flags

Signs and symptoms of endometrial cancer recurrence include the following:

  • Abdominal distension
  • Detection of a mass
  • Diarrhea, nausea, or vomiting
  • Fatigue
  • Persistent cough
  • Persistent pain, especially in the abdomen, pelvis, or back/flank
  • Swelling
  • Unexplained vaginal bleeding or discharge
  • Unexplained weight loss
  • Urinary or bowel obstruction

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Referrals for Recurrence

Patients should be referred back to their treating oncologist. If the oncologist’s contact information is not available, please search “endometrial cancer” in the Alberta Referral Directory for the most up-to-date information and instructions for referral.

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Complications & Late Effects of Treatment

Following treatment for endometrial cancer, your patient may present with some of the complications outlined below. Continue to monitor and address concerns related to cancer therapy.

 
Complication Treatment-Related Causes Actions
Fatigue
  • Radiation
  • Chemotherapy
 Fatigue should start to improve within months of treatment completion. Persistent or recurrent fatigue warrants further work-up to rule out other potential causes.
Peripheral neuropathy
  • Taxane-chemotherapy
 Peripheral neuropathy should improve over months.
Lymphedema
  • Surgery
  • Radiation
 Early symptoms include leg heaviness or discomfort and may be present with/without overt swelling. Referral to local rehabilitation services (e.g. physiotherapy) or lymphedema clinic can be made. More information can be found in the lymphedema resource.
Chronic GI symptoms
  • Radiation
  • Surgery
 Symptoms such as chronic diarrhea, fecal leakage, and pain should be treated as appropriate. Referral to GI for ongoing management can be considered.
Psychosocial distress
  • Stress of cancer treatment
  • Fear of recurrence
  • Post-treatment adjustments
 Increasing helplessness/hopelessness, distress, anxiety or depression may be present. Patients experiencing these symptoms should be encouraged to inform their oncology treatment team for appropriate psychosocial referral. More information about fear of recurrence can be found in the FCR resource.
Sexual dysfunction
  • Radiation
  • Surgery
 Vaginal shortening, pain, decreased lubrication, and decreased arousal may occur. See below for more information.
Menopausal symptoms
  • Radiation
  • Chemotherapy
  • Surgery
  • Hormones
 Some patients will experience new symptoms of menopause after treatment. During the active follow-up phase, patients manifesting symptoms of menopause such as vaginal dryness and hot flashes will be monitored as applicable by the oncology treatment team.
 

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Specific Concerns for Endometrial Cancer Patients

Menopause Symptoms

  • Most endometrial cancers occur in post-menopausal women. Some patients will experience new symptoms of menopause after treatment.
    • The use of hormone replacement therapy (HRT) in these women is controversial and there is little evidence about its safety.
  • Women with low-risk disease may be acceptable candidates for HRT after appropriate discussion about benefits and side effects with the patient.
  • In women with high-risk disease or other contraindications to HRT, non-hormonal options are preferable.
  • For refractory vaginal or other sexual health symptoms, referral to gynecology and/or sexual health experts should be considered.

More information about menopause symptoms is found in the Endometrial Cancer Transfer of Care Physician Letter.

Genetic Counselling

  • Patients should be encouraged to report any changes in their family history of cancer.
  • A small percentage of endometrial cancers may be caused by an inherited predisposition to cancer.
  • All women with a strong family history of cancer should be offered a referral to genetic counselling.
  • For referral information, see the AHS Clinical & Metabolic Genetics Program.

Sexual Health

The Oncology and Sexuality, Intimacy, and Survivorship (OASIS) program assists patients to manage physical and emotional concerns.

More information about sexual health, including OASIS services, is found in the Endometrial Cancer Transfer of Care Physician Letter.

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Note: The information on this page was adapted from the AHS Guideline Resource Unit’s Endometrial Cancer Guideline, and the accompanying Endometrial Cancer Transfer of Care Physician Letter. Also available is the Endometrial Cancer Transfer of Care Patient Letter.