Treatment of Intermediate-Risk Endometrial Carcinoma: Stage IBm, IIAm, and IICm
This protocol covers endometrial carcinoma that meets the criteria for intermediate risk, defined by a specific combination of disease stage, molecular classification, histological grade, and oestrogen receptor status.
Clinical Scenario
Intermediate risk is defined across three distinct staging categories:
- Stage IBm — MMRd or NSMP, low-grade, oestrogen receptor-positive
- Stage IIAm — NSMP, low-grade, oestrogen receptor-positive
- Stage IICm — MMRd, with myoinvasion, without cervical stromal invasion and without substantial lymphovascular space invasion
Treatment Approach
Management in this setting is surgical, carried out via a minimally invasive approach as the standard. The complete operative procedure, lymph node staging method, and all further management specifications are detailed in the full protocol.
References
DOI: 10.1016/S1470-2045(25)00167-6
- Intermediate risk includes three categories (figures 3, 4; yellow cells).
- First, stage IBm MMRd or NSMP low-grade and oestrogen receptor-positive endometrial carcinoma.
- Second, stage IIAm NSMP low-grade and oestrogen receptor-positive endometrial carcinoma.
- Third, stage IICm MMRd endometrial carcinoma with myoinvasion (regardless of depth of myometrial invasion), without cervical stromal invasion and without 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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