Should Endometrial Cancer Treatment Be Centralized?

SIMPLE SUMMARY: Endometrial cancer (EC) is the most frequent cancer of the female genital tract in Western and emerging countries. It is commonly thought to be easy to treat as it is usually diagnosed at an early stage, and hysterectomy with bilateral adnexectomy alone is the only treatment required. The progressive replacement of systematic lymphadenectomy with sentinel lymph node biopsy has also fostered this erroneous belief. In fact, if mistreated, EC has a high lethality due to its poor response to chemotherapy in the cases of advanced stage and recurrence. In this paper we reviewed the literature to understand whether the treatment of EC should be reserved for gynecologic oncologists and whether treatment of EC patients should be centralized in high-volume hospitals. We also evaluated the contribution of other specialists involved in the diagnostic and therapeutic pathways of EC. Finally, we suggest a possible network to treat EC patients to ensure effective staging and treatment. ABSTRACT: Endometrial cancer (EC) is the most common malignancy of the female genital tract in Western and emerging countries. In 2012, new cancer cases numbered 319,605, and 76,160 cancer deaths were diagnosed worldwide. ECs are usually diagnosed after menopause; 70% of ECs are diagnosed at an early stage with a favorable prognosis and a 5-year overall survival rate of 77%. On the contrary, women with advanced or recurrent disease have extremely poor outcomes because they show a low response rate to conventional chemotherapy. EC is generally considered easy to treat, although it presents a 5-year mortality of 25%. Though the guidelines (GLs) recommend treatment in specialized centers by physicians specializing in gynecologic oncology, most women are managed by general gynecologists, resulting in differences and discrepancies in clinical management. In this paper we reviewed the literature with the aim of highlighting where the treatment of EC patients requires gynecologic oncologists, as suggested by the GLs. Moreover, we sought to identify the causes of the lack of GL adherence, suggesting useful changes to ensure adequate treatment for all EC patients.