Gretchen E. Glaser, M.D. , and Evelyn A. Reynolds, M.D. , gynecologic oncology consultants, discuss the symptoms of endometrial cancer, risks associated with this cancer, how Mayo Clinic approaches treatment, and what patients can expect after treatment and surgery.
One of the most exciting things about Mayo Clinic is that we have been leaders in innovative surgical treatment for endometrial cancer for about 2 decades. The most common presenting symptom is abnormal uterine bleeding, so any bleeding, particularly after menopause, is not normal and needs to be evaluated. Pre-menopausal patients, if you're having a change in your cycle or abnormality, it could be a sign of pre-cancerous or cancerous changes. Other symptoms. Be lower abdominal pain, cramping, and also difficulty with bowel and bladder movements. Early detection is so critical because if you catch an endometrial cancer in stage one, most of the time surgery will be the only needed treatment. The best way to approach this is to see your physician immediately if you have any postmenopausal bleeding or abnormal uterine bleeding in people who are still having periods. We approach endometrial cancer with a very collaborative and multidisciplinary approach. We have a special program within our gynecologic oncology division for complex surgery and. That includes our patients with advanced and recurrent endometrial cancer. Every week on Friday morning, our tumor board meets, and this includes gynecologic oncologists, medical oncologists, radiation oncologists, radiologists, pathologists, and even orthopedic oncologists who all get together to talk about a patient's particular situation and determine what the best approach will. We are very systematic in our approach of all patients ensuring that they are getting the most up to-date guidelines specific care to treat their cancer. Surgery is a key part of the treatment, but it's not the only part of it. We rely on our pathology team with the recent updates in the staging guidelines in 2023, molecular. Testing is really instrumental to individualize the treatment for the patient. The majority of our patients with endometrial cancer are managed with robotic surgery. The minimally invasive approach allows the majority of patients to leave the hospital the same day. So if patients are being referred and they prefer to have surgery within a short time frame. That is usually very easy to accomplish. We use robotic surgery, we use sentinel lymph node mapping, we use the firefly technology, which helps us with sentinel lymph node mapping. And then once your specimen comes out, it goes to fellowship trained gynecologic pathologists. About 75% of patients with a grade 1 endometrial tumor will have no disease outside of the uterus and not need any further treatment. But that means 25% will have some disease outside of the uterus, and we want to make sure we find it. The sentinel lymph nodes are the most common place for cells to leave the uterus and go. It's the first place they go before they would go other places in the body. By identifying the sentinel lymph nodes, we are most likely to find any metastatic cells that go outside of the uterus. So that's where the multidisciplinary approach is key. We really rely on our pathologists to detect even just a few cells in a lymph node. Our pathology department and their ability both with frozen section and to adopt these molecular markers for further testing of the tumor very quickly. Our pathologists have gone through additional training to be really good at endometrial cancer, and they not only look at your specimen in a very detailed way, but they're also able to order molecular testing that is. edge and really helps us determine whether you would need any additional treatment. We therefore have a large frozen section lab within every operating room suite, and it only takes the pathologist about 20 minutes to give us an answer of what is going on in the uterus with 98% certainty. Our frozen pathology results only change about 2% of the time, which is vastly different from the rest of the country. Because we get so many outside referrals, um, really my team is geared to make sure that the referring physician gets all the information they need. So from my initial consult that will be sent updates on their surgery. Pathology. Another thing we do is referring providers are always welcome to contact us about anything that happens with the patient afterward that they have questions about so many times we will have lovely back and forth conversations that are really rich to keep patients in the best possible care. After surgery, if it's done robotically, many of them are able to leave the hospital the same day. Usually, you're able to resume most activities within 6 weeks, and that's, that's what's good to hear, you know, that you've been able to treat their cancer, but they've, you know, been able to leave the hospital and, and feel good just within days of surgery. It's remarkable.
