Increased incidence of advanced stage endometrial cancer: a retrospective analysis of different clinical approaches and tumour biology

Introduction: An increasing percentage of advanced FIGO Stage has been observed among endometrial cancer patients referred to this department within the last five years. During the same time period, the diagnostic method used changed from D&C to office hysteroscopy (HSC) with a prolongation of waiting times for biopsy and surgery. The authors analyzed potential reasons for increased percentage of advanced stage disease. Materials and Methods: 499 consecutive new endometrial cancer patients were included from 2005 to 2015. The authors analyzed characteristics of the, diagnostic method, waiting times for biopsy and surgery, occurrence, duration of abnormal uterine bleeding (AUB), and hormonal treatment (gestagen) for AUB. A comparison between FIGO Stage I vs. II or more was performed. Results: The increase in advanced FIGO Stage disease was significant. Characteristics other than stage did not significantly change. The duration of AUB was the same. Gestagen for AUB was used almost three-fold more often during the last two years. Comparison between FIGO Stage I vs. II or more showed the stage was solely associated with tumor biology. Conclusions: The FIGO Stage of the disease was associated with more aggressive tumours whereas the diagnostic method, prolonged waiting times for biopsy and surgery, and a more conservative approach to AUB or several years of history of AUB were not associated with advanced disease.

Endometrial carcinoma; FIGO staging; Hysteroscopy; Dilatation and curettage; Time to diagnosis.

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