Recommendations for the Diagnosis and Treatment of Endometrial Cancer, Update 2013

Introduction

The S2k guideline “Diagnosis and Treatment of Endometrial Cancer” was published on June 1, 2008; some of the recommendations in the guideline are still up-to-date; however, others are out-of-date and no longer apply. The update will be carried out in accordance with the requirements of the German National Cancer Plan and will lift the guideline into the S3 category. We expect that the funding required for the update will be available from the 2nd half of this year. Even if work starts promptly, the S3 guideline will only be available from the beginning of 2016 at the earliest. As an interim solution for the period for which no guideline is available, the Uterus Commission ([Table 2]) has issued recommendations for the diagnosis and treatment in April 2011, which were since updated in April 2013. The FIGO/TNM staging system ([Table 1]) was used.

Table 1 The new FIGO/TNM classification for endometrial cancer.

TNM categories	FIGO stages	Definitions
1 Endocervical glandular involvement should only be considered as stage I. 2 Positive cytology must be diagnosed separately and recorded without changing the stage. 3 Bullous edema is not sufficient to classify a tumor as T4. Invasion of bladder mucosa or bowel mucosa must be confirmed with biopsy.
TX		Primary tumor cannot be assessed
T0		No evidence of primary tumor
T1	I1	Tumor confined to corpus uteri
T1a	IA1	Tumor limited to endometrium or invades less than one half of the myometrium
T1b	IB	Tumor invades one half or more of the myometrium
T2	II	Tumor invades stromal connective tissue of the cervix but does not extend beyond uterus
T3 and/or N1	III	Local and/or regional extension or metastasis as described below:
T3a	IIIA	Tumor involves serosa or adnexa (direct extension or metastasis)
T3b	IIIB	Vaginal involvement or parametrial involvement (direct extension or metastasis)
N1	IIIC	Metastasis to pelvic and/or para-aortic lymph nodes2
	IIIC1	Metastasis to pelvic lymph nodes
	IIIC2	Metastasis to para-aortic lymph nodes
T4	IVA	Tumor invades bladder mucosa and/or bowel mucosa3
M1	IVB	Distant metastasis (excludes metastasis to the vagina, pelvic serosa or adnexa; includes metastasis to inguinal and intra-abdominal lymph nodes other than para-aortic and/or pelvic lymph nodes)

Table 2 Uterus Commission of AGO of the DGGG (German Society for Gynecology and Obstetrics) and the DKG (German Cancer Society).

Gynecological Oncology

Prof. Dr. M. W. Beckmann, Erlangen

Prof. Dr. D. Denschlag, Bad Homburg

Prof. Dr. G. Emons, Göttingen

Priv.-Doz. Dr. M. Fleisch, Düsseldorf

Prof. Dr. P. Hillemanns, Hannover

Dr. I. Juhasz-Böss, Homburg/Saar

Prof. Dr. L. Kiesel, Münster

Prof. Dr. R. Kimmig, Essen

Priv.-Doz. Dr. C. Köhler, Berlin

Prof. Dr. B. Lampe, Düsseldorf

Prof. Dr. W. Lichtenegger, Berlin

Prof. Dr. P. Mallmann, Cologne (Commission spokesman)

Priv.-Doz. Dr. H. Pilch, Cologne

Priv.-Doz. Dr. D. Rein, Cologne (Deputy Commission spokesman)

Prof. Dr. I. Runnebaum, Jena

Priv.-Doz. Dr. E. Steiner, Rüsselsheim

Dr. H. Strauss, Halle/Saale

Prof. Dr. C. Tempfer, Herne

Prof. Dr. U. Ulrich, Berlin

Radiation Oncology

Prof. Dr. S. Marnitz, Berlin

Prof. Dr. V. Strnad, Erlangen

Prof. Dr. D. Vordermark, Halle/Saale (ARO representative)

Pathology

Prof. Dr. L. C. Horn, Leipzig

Prof. Dr. D. Schmidt, Mannheim