Table 4.

Endometrial cancer: priorities in surgical, medical and radiation oncology care

High priority	Medium	Low
Surgical oncology
Uterine/pelvic haemorrhage. Radiologically confirmed peritonitis. Complication during/after RT for primary tumour/pelvic recurrence (fistulisation/bowel perforation). Acute postsurgery complications (perforation or ureteral dissection, bleeding).	Hysterectomy (±BSO)+SLN sampling/lymphadenectomy in newly diagnosed endometrial cancer apparently confined to the uterus.	Risk-reducing surgery for genetic predisposition to endometrial cancer. AH/EIN not controlled with HT. Reparation of asymptomatic fistula. Resection of slowly growing central recurrence.
Medical oncology
ChT in previously untreated symptomatic metastatic or recurrent disease not sensitive to HT. Continuation of medical treatment in the context of a clinical trial.* ChT±RT post surgery in high-risk patients	Metastatic/recurrent disease slowly growing potentially hormone-sensitive (G1–2, hormone receptors-positive, consider HT).	Second-line ChT in patients not suitable for HT.
Radiation oncology
EBRT±ChT post surgery in high-risk patients. RT for symptomatic unresectable primary tumour not suitable for surgery.	Brachytherapy in intermediate–high risk. RT with curative intent for isolated vaginal relapse after surgery.	RT for asymptomatic vaginal/pelvic recurrence.

*For patients on clinical trials, seek information about changes in management for individual studies from the coordinating trials unit for treatment frequency, blood investigations and imaging.

AH, atypical hyperplasia; BSO, bilateral salpingo-oophorectomy; ChT, chemotherapy; EBRT, external beam radiotherapy; EIN, endometrial intraepithelial neoplasia; G, grade; HT, hormonal therapy; RT, radiotherapy; SLN, sentinel lymph node.