How often will follow-up be performed to monitor for endometrial cancer recurrence?

Posted 2 months ago by Andreas Obermair

In my practice we outline a post-treatment plan for patients diagnosed with endometrial cancer to ensure the early detection and prompt intervention of any potential recurrence.

Women who have undergone treatment for endometrial cancer face the possibility of local, regional, or distant recurrence. Rates of recurrence for early stage endometrial cancer are low, with less than 5% of patients affected. Recurrence typically occurs within the initial 2 to 3 years post-diagnosis. Recurrences often develop locally, at the top of the vagina, exhibit symptoms, and are highly treatable. The risk diminishes significantly for asymptomatic women after more than 5 years post diagnosis. A simple inspection at the time of vaginal examination will address this concern.

Follow-up care is also integral for identifying, monitoring, and managing treatment-related side effects and co-morbidities. Addressing co-morbidities such as those related to obesity, hypertension, and diabetes is crucial, as evidence suggests cardiovascular disease is a leading cause of death among endometrial cancer patients.

The follow-up schedule that I recommend, involves more frequent visits in the first 2 to 3 years after treatment due to the heightened risk during this period.

Signs of recurrence may include vaginal bleeding or pelvic pain. If experiencing symptoms, don’t wait for your next scheduled visit and contact your doctor promptly.

Suggested follow-up schedule for asymptomatic (not showing signs of recurrence) women following treatment for early stage low-risk endometrial cancer:

Year 1-2: Every 3-6 months

Year 3: Every 6-12 months

Year 4-5: Every 12 months

I will offer patients who have a higher risk of recurrence to be seen more frequently and for at least five years.

For some patients follow-up appointments are reassuring; however, for other patients they may be anxiety-inducing due to the fear of recurrence.

At the visit I will ask about your health to ensure there are no new, persistent or progressive symptoms that may indicate recurrence, such as bleeding or pain. A physical examination is performed including an abdominal, pelvic and gynaecological examination. If I can see any abnormality I will recommend a small biopsy to clarify the issue. At the visit I will identify, monitor and manage effects of treatment, including effects on bladder and bowel function and lymphoedema. Additionally, active promotion of secondary prevention strategies, realistic goal-setting, and lifestyle modifications, including maintaining a healthy body weight, regular exercise, smoking cessation, and limiting alcohol intake, are encouraged to improve overall outcomes.

Routine tests like PAP smears or radiological examinations have not been shown to advance patient outcomes in asymptomatic women. Therefore I will not routinely recommend them.

Ongoing tests or clinical reviews may not be necessary for every endometrial cancer patient, and I will often offer discharge for general practice follow-up for some patients.

In summary, follow-up appointments after cancer treatment achieve several purposes. They are good for monitoring patients' health, detecting potential recurrence early, and managing treatment-related side effects. These appointments allow your surgeon, like me to conduct thorough assessments, including physical examinations and relevant tests, ensuring timely intervention if signs of recurrence emerge.

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