Endometrial Cancer
Admission & discharge
Admission/discharge guidance checked 2026-10-18 against the linked sources. This is a clinical checklist for an individual decision, not an automatic discharge order.
Admission triage and treatment-specific handover for oncology modules. Definitive cancer-treatment discharge criteria and systemic-therapy orders remain the responsibility of the treating MDT; this is not a chemotherapy protocol.
When admission or continued hospital care is needed
- Major bleeding, bowel/urinary obstruction, uncontrolled pain, dehydration, VTE, sepsis or an unwell patient receiving anticancer therapy needs urgent hospital assessment.
- Suspected neutropenic sepsis is an emergency; only a specialist risk-assessed pathway can support later outpatient care.
When clinic, day care or home care may be suitable
- A stable suspected/diagnosed malignancy does not automatically require emergency admission. Arrange an urgent named gynaecological-oncology/MDT pathway and track tissue/imaging results.
Before going home
- The acute problem is controlled and the treating team has agreed treatment-specific discharge criteria; oral intake, pain, mobility and any wound/drain/stoma/catheter plan are feasible.
- The patient has the cancer-team emergency contact and a named owner/date for pathology, staging and the next treatment decision.
Discharge medicines and treatment changes
- Reconcile analgesia, anticoagulation, supportive and any antimicrobial treatment with the oncology team. Chemotherapy/hormonal anticancer prescriptions are specialist- and regimen-specific.
Tests, pending results and their reviewer
- List pathology, imaging, blood/organ-function results and outstanding investigations, with the MDT/clinician responsible for acting on them.
Home care and counselling
- Teach care of any wound/drain/stoma/catheter; discuss nutrition, function, fertility/sexual health and emotional/practical support according to the actual treatment.
- If hysterectomy was performed, explain the operation/pathology plan and any consequences for fertility and ovarian function.
Follow-up: when and what to review
| When | Action / responsible service |
|---|---|
Before leaving | Provide the booked oncology/MDT-result review and procedure/device appointments. |
During anticancer treatment | Follow the regimen-specific blood tests and 24-hour unwell/fever contact instructions; do not wait for routine review when ill. |
Return urgently
- Fever/rigors or feeling acutely unwell during anticancer treatment, heavy bleeding, inability to pass urine/stool with pain/vomiting, chest symptoms or collapse needs immediate assessment.
Treatment
① Immediate stabilization — first minutes
Hyperplasia-with-atypia in fertility-desire: progestogen therapy + hysteroscopy-guided surveillance at specialist centres.
③ First-line treatment & drug regimens
- PRIMARY SURGERY: hysterectomy + BSO (+/- sentinel node mapping/peritoneal washings) - staging quality drives adjuvant decisions
- ADJUVANT therapy by FIGO-2023/ESGO risk group: low-risk none; intermediate brachytherapy consideration; high-risk EBRT(+chemo); advanced chemo±radiotherapy combinations
- POLEmut stage I-II: consider omitting adjuvant; p53abn with myoinvasion: escalate
Definitive treatment
Complete surgical staging with molecular-integrated risk assignment; metastatic disease -> platinum-based systemic therapy at oncology centre.
Monitoring
| Follow-up | Schedule |
|---|---|
Clinical review | q3-6 months x2 y then annually (symptom-led vaginal assessment) |
Imaging | Only if symptomatic/recurrence suspicion (routine scans low-yield) |
Response assessment
- Final pathology concordant staging; adjuvant plan documented at MDT
Treatment failure
- Vaginal recurrence -> radiotherapy ± surgery; distant recurrence -> systemic trials/oncology
Second-line treatment
- MMRd recurrent: PD-1 inhibitor options (oncology-led); hormonal agents indolent cases
Rescue treatment
Not applicable - oncology pathways.
Procedure / surgery
Surgical pages queued v1.1 (hysterectomy/staging).
Escalation
- ALL confirmed carcinomas discussed at gynae-oncology MDT; surgery at accredited centres
⑮ Complications & their management
Treatment-related morbidity
Lymphoedema services; pelvic radiotherapy bowel management programmes
Post-treatment care
- Lymphoedema/vaginal-health support; HRT discussion individualised after early-stage
Diagnosis & assessment
- Postmenopausal bleeding (90% present so)
- Thickened endometrium on TVS postmenopause
- Cervical involvement on biopsy
- Rising CA125 with uterine mass
Definition: Malignancy of endometrial epithelium - majority endometrioid (oestrogen-driven), aggressive types serous/clear cell/carcinosarcoma.
Initial assessment
- Pipelle/outpatient biopsy -> histology
- TVS endometrial thickness
- Staging imaging: MRI pelvis + CT chest/abdo (or PET where available)
- Serum CA125
- Molecular classification panel requested (MMR-IHC minimum; POLE/p53 as available)
Investigations
| Test | Looking for |
|---|---|
Endometrial biopsy/hysteroscopy-D&C | Histology + grade |
MRI pelvis | Myometrial/cervical invasion planning |
MMR-IHC +/- POLE/p53 | Molecular class (FIGO 2023 integration) |
Sources (9)
2023-06 · checked 2026-08-23 · verified-live
Open source ↗
FIGO announcement + PubMed abstract with full substage definitions
2025-07/08 (Lancet Oncology) · checked 2026-08-23 · verified-live
Open source ↗
ESGO guidelines portal + Lancet Oncology abstract + pocket-guideline content (risk-group tables, molecular-classification requirements, adjuvant strategy)
· checked 2026-10-18 · verified-live
Open source ↗
Full primary recommendation page read for postmenopausal bleeding, cervical/ovarian/endometrial concern and referral/result follow-through. Supports triage/referral only; it does not supply chemotherapy or tumour-specific postoperative discharge regimens.
· checked 2026-10-18 · verified-live
Open source ↗
Primary recommendations read: unwell patients receiving anticancer treatment need immediate assessment and suspected neutropenic sepsis is an acute emergency; only a trained specialist using an appropriate risk assessment selects outpatient care.
· checked 2026-10-18 · verified-live
Open source ↗
Full primary patient recovery page read: pain control, wounds, activity/VTE, urinary/bowel and infection warning signs, adult support and no driving/important decisions during the first 24 hours after general anaesthesia. Used as general recovery/handover principles, not operation-specific discharge…
· checked 2026-10-18 · verified-live
Open source ↗
Maternal/newborn transfer assessment, first void and effective feeding, handover, support/safeguarding, first midwife visit within 36 hours after transfer, postnatal danger symptoms. Full recommendations page read.
· checked 2026-10-18 · verified-live
Open source ↗
Normal-delivery discharge not less than 48 hours: full primary SOP PDF normal-delivery/discharge passages read. Corroborated by NHM CEmONC 2024 Part 1, chapter 8. This does not define a universal post-caesarean or complicated-case stay.
· checked 2026-10-18 · verified-live
Open source ↗
Official WHO summary read: at least 24-hour facility care after birth; additional contacts at 48–72 hours, 7–14 days and week 6; individual assessment/support. Summary facts only, not a claim that the full 242-page PDF was reviewed.
· checked 2026-10-18 · verified-live
Open source ↗
Full primary recommendations read, focusing on critical-care-to-ward transfer: structured written handover, shared plan, monitoring, rehabilitation and receiving-team capability. Step-down is distinct from home discharge; no universal organ-support discharge cutoff is asserted.