The goal of monitoring is to detect recurrence as soon as it occurs; however, there is no evidence that this impacts on survival, and it may worsen anxiety and lead to expensive investigations and over-treatment.
Most recurrences (65% to 85%) occur within 3 years of treatment and are symptomatic.[9]Koskas M, Amant F, Mirza MR, et al. Cancer of the corpus uteri: 2021 update. Int J Gynaecol Obstet. 2021 Oct;155 Suppl 1(suppl 1):45-60.
https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.13866
http://www.ncbi.nlm.nih.gov/pubmed/34669196?tool=bestpractice.com
Clinical follow-up should focus on signs and symptoms suggestive of recurrence, such as vaginal bleeding, abdominal or pelvic pain, persistent cough, unexplained weight loss, and new-onset neurological symptoms.
The clinician can use the following schedule for follow-up:[83]National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: uterine neoplasms [internet publication].
https://www.nccn.org/guidelines/category_1
Imaging based on symptoms or examination findings that suggest recurrence.
Vaginal cytology, serum CA-125, and annual chest x-ray have no proven role in follow-up.[270]Cancer Care Ontario Program in Evidence-based Care Gynecology Cancer Disease Site Group. Follow-up after primary therapy for endometrial cancer: a systematic review. Jan 2006 (endorsed Jun 2017) [internet publication].
https://www.cancercareontario.ca/en/guidelines-advice/types-of-cancer/616
[271]Zola P, Ciccone G, Piovano E, et al. Effectiveness of Intensive Versus Minimalist Follow-Up Regimen on Survival in Patients With Endometrial Cancer (TOTEM Study): A Randomized, Pragmatic, Parallel Group, Multicenter Trial. J Clin Oncol. 2022 Nov 20;40(33):3817-3827.
https://ascopubs.org/doi/10.1200/JCO.22.00471?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
http://www.ncbi.nlm.nih.gov/pubmed/35858170?tool=bestpractice.com
Patient-initiated or nurse-led follow-up may be an option for some low-risk patients.[9]Koskas M, Amant F, Mirza MR, et al. Cancer of the corpus uteri: 2021 update. Int J Gynaecol Obstet. 2021 Oct;155 Suppl 1(suppl 1):45-60.
https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.13866
http://www.ncbi.nlm.nih.gov/pubmed/34669196?tool=bestpractice.com
[96]Crosbie EJ, Kitson SJ, McAlpine JN, et al. Endometrial cancer. Lancet. 2022 Apr 9;399(10333):1412-28.
http://www.ncbi.nlm.nih.gov/pubmed/35397864?tool=bestpractice.com