Diagnosis and Management of Endometrial Cancer

This episode of JAMA Clinical Reviews features Dr. Karen McLean, a professor of gynecologic oncology at Roswell Park Comprehensive Cancer Center, discussing the diagnosis, risk factors, and management of endometrial cancer. She highlights that endometrial cancer is now the fourth most common cancer in U.S. women and the leading cause of gynecologic cancer deaths, with rising incidence and mortality linked to obesity and increasing rates of aggressive histologic subtypes. Key risk factors include unopposed estrogen from obesity, tamoxifen, and nulliparity, as well as hereditary syndromes like Lynch syndrome. Dr. McLean emphasizes the importance of recognizing abnormal postmenopausal bleeding as the primary symptom, while noting that Black women may present with less typical symptoms such as pelvic pain and anemia, and that the standard 4 mm endometrial thickness threshold for ultrasound may miss cancers in this population. She stresses that biopsy remains the gold standard for diagnosis, especially in persistent bleeding, regardless of age. Treatment is primarily surgical, with minimally invasive approaches preferred, followed by adjuvant therapy based on stage and histology, including chemotherapy (carboplatin and paclitaxel) and immunotherapy (pembrolizumab or dostarlimab) for advanced or aggressive disease. A critical takeaway is the high prevalence of sexual health dysfunction post-diagnosis, which providers should proactively address. The episode concludes with a strong recommendation for all patients to be referred to a gynecologic oncologist for personalized care and prognosis discussion.