Surveillance for Stage III Mixed Uterine Cancer
For stage III mixed (high-risk) uterine cancer, follow patients every 3 months for the first 2 years, then every 6 months for years 3-5, and annually thereafter, with history, physical examination including speculum and pelvic exam at each visit, and imaging only as clinically indicated. 1
Surveillance Schedule
Years 0-2 (Months 0-24)
- Visit every 3 months 1
- Comprehensive history focusing on symptoms of recurrence (vaginal bleeding, pelvic pain, abdominal distension, weight loss) 1
- Physical examination including speculum, bimanual pelvic, and rectovaginal examination (26-50% of recurrences occur in the pelvis) 1
Years 3-5 (Months 24-60)
Beyond 5 Years
Imaging and Laboratory Testing
Routine Surveillance
- No routine imaging is recommended (CT, MRI, PET-CT, or chest X-ray) in asymptomatic patients 1
- CA-125 has insufficient data to support routine use 1
- Pap smear/cytology is not indicated for surveillance 1
When Recurrence is Suspected
- CT and/or PET-CT scan should be obtained when clinical examination or symptoms suggest recurrence 1
- Further investigations (CT, MRI, blood tests, examination under anesthesia) can be requested if clinically indicated 1
Important Caveats
Detection Methods
- 41-83% of recurrences are detected by symptoms alone, making patient education about warning signs critical 1
- Physical examination detects 35-68% of recurrences 1
- Most recurrences in endometrial cancer occur within the first 3 years, justifying the more intensive early surveillance 1
Additional Screening Considerations
- Screen for secondary malignancies (breast, ovary, colon) during surveillance visits, as patients with endometrial cancer have increased risk 1
- Consider genetic counseling/testing for patients under 50 years old or those with significant family history of endometrial/colorectal cancer to evaluate for Lynch syndrome 1
Mixed Histology Considerations
Mixed uterine cancers (containing high-risk histologies like serous, clear cell, or carcinosarcoma components) warrant the high-risk surveillance schedule due to their aggressive behavior and propensity for both local and distant recurrence 1, 2, 3. These tumors account for disproportionate endometrial cancer deaths despite representing a minority of cases 2, 3.