Treatment of Endometrial Carcinoma Classified as High-Intermediate Risk
Clinical Scenario
This protocol applies to patients with endometrial carcinoma assigned to the high-intermediate risk group based on molecular and pathological classification. Three categories define this risk tier:
- Stage IIAm with mismatch-repair deficiency (MMRd)
- Stage IIBm with MMRd; or NSMP low-grade and oestrogen receptor-positive
- Stage IICm with MMRd and cervical invasion (independent of lymphovascular space invasion), or with substantial lymphovascular space invasion
Treatment Approach
The standard surgical approach for this population involves a specific combination of uterine surgery and lymph node evaluation, performed via a minimally invasive technique.
Full operative details, staging procedure, and institutional considerations are in the complete protocol →
References
DOI: 10.1016/S1470-2045(25)00167-6
- High–intermediate risk includes three categories (figures 3, 4; orange cells).
- First, stage IIAm MMRd endometrial carcinoma.
- Second, stage IIBm MMRd, or NSMP low-grade and oestrogen receptor-positive endometrial carcinoma.
- Third, stage IICm MMRd endometrial carcinoma with cervical invasion (independent of lymphovascular space invasion) or with substantial lymphovascular space invasion.
- Standard surgery for stage I and II endometrial carcinoma is total hysterectomy with bilateral salpingo-oophorectomy and lymph node staging (II, A for stage I and IV, B for stage II).
- Sentinel lymph node biopsy should be done for staging purposes in all patients with presumed uterus-confined disease (II, A).
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