Current diagnosis and treatment of endometrial cancer

Endometrial cancer (EC) is the fourth most common cancer in women in Germany. The incidence increases with an increase in risk factors. Due to bleeding disorders in premenopausal and postmenopausal bleeding, predominantly early stages are diagnosed by hysteroscopy with fractionated abrasion. Pathologically, EC can be subdivided into type I (estrogen-dependent endometroid adenocarcinomas) and type II disease (estrogen-independent serous, clear cell carcinomas). While type I tumors have a better prognosis, type II carcinomas have a significantly worse prognosis. Minimally invasive treatment by laparoscopic total hysterectomy with bilateral adnexectomy created the gold standard of treatment in early-stage endometroid adenocarcinomas. In advanced stages, paraaortic and pelvic lymphonodectomy or omentectomy are additionally required for type II carcinomas. Recent scientific achievements in molecular typing of carcinoma have created new challenges in routine patient care. Polymerase epsilon (POLE)-mutated tumors have a very good prognosis, microsatellite instability (MSI)-hypermutated and copy-number low (also NSMP = no specific molecular risk profile) show intermediate prognosis, while and copy-number high (also TP53-mutated) have the worst prognosis. L1CAM positivity (>= 10% of tumor cells) has been shown to be another poor prognostic feature.