Endometrial Cancer Supportive Care Protocol

Endometrial cancer is cancer that begins in the lining of the uterus (endometrium). It is the most common gynecological cancer in developed countries, with most cases occurring after menopause.

TYPES:

•Type I (80-90%): Estrogen-dependent, typically endometrioid adenocarcinoma, usually better prognosis

•Type II (10-20%): Non-estrogen-dependent, includes serous and clear cell, more aggressive

RISK FACTORS:

•Obesity (major risk factor)

•Diabetes

•PCOS (polycystic ovary syndrome)

•Estrogen therapy without progesterone

•Tamoxifen use

•Nulliparity (never having given birth)

•Early menarche/late menopause

•Lynch syndrome (hereditary)

SYMPTOMS:

•Abnormal uterine bleeding (especially postmenopausal)

•Pelvic pain

•Pain during intercourse

•Unexplained weight loss (advanced)

CRITICAL: Endometrial cancer requires specialized gynecologic oncology care. This protocol is SUPPORTIVE ONLY.

TREATMENT:

•Surgery: Total hysterectomy with bilateral salpingo-oophorectomy (standard)

•Radiation: Vaginal brachytherapy and/or external beam

•Chemotherapy: For advanced or high-risk disease

•Hormone therapy: For select cases

•Immunotherapy: For MSI-high/dMMR tumors

NUTRITIONAL GOALS:

•Maintain healthy weight (obesity worsens outcomes)

•Support immune function

•Manage treatment side effects

•Adequate protein for healing

* Vitamin D supports immune function and is often deficient.

* Protein helps maintain muscle mass during treatment.

* Ginger may help with chemotherapy-induced nausea.

Expected timeline: Treatment is typically surgical with adjuvant therapy as needed. Supportive care continues through treatment and recovery.

Clinical Perspective

Endometrial Cancer: Most common gynecologic malignancy in developed countries. Types: Type I (endometrioid, estrogen-driven, 80-90%, better prognosis), Type II (serous, clear cell, non-estrogen, 10-20%, worse prognosis). Risk factors: obesity (RR 2-4), diabetes, PCOS, unopposed estrogen, tamoxifen, nulliparity, Lynch syndrome. Staging: FIGO surgical staging.

CRITICAL: Surgery is primary treatment - total hysterectomy with BSO, lymph node assessment. Adjuvant therapy based on risk stratification (stage, grade, histology, LVSI). Checkpoint inhibitors revolutionizing treatment of MSI-H/dMMR tumors (pembrolizumab). Supplements are supportive only - no evidence they affect cancer outcomes. Focus on nutrition, managing treatment side effects, weight management.

* Vitamin D (C-grade): Immune support. Systematic review: (PMID: 28750270). 2000-4000 IU daily.

* Omega-3 Fatty Acids (C-grade): Anti-inflammatory. Systematic review: (PMID: 27840029). 2-3g EPA+DHA daily.

* Protein (B-grade): Nutrition. Guidelines: (PMID: 28332116). 1.2-1.5g/kg/day.

* Curcumin (C-grade): Anti-inflammatory. Review: (PMID: 25282711). 500-2000mg daily.

* Green Tea Extract (C-grade): EGCG effects. Review: (PMID: 26882542). 300-500mg EGCG daily.

* Probiotics (C-grade): GI support. Review: (PMID: 29882905). 10-20 billion CFU daily.

* Ginger (B-grade): CINV. Systematic review: (PMID: 27841938). 250-1000mg daily.

Assessment targets: CA-125 (Type II), imaging surveillance, symptom management, nutritional status.

Protocol notes: Obesity: major modifiable risk factor; weight loss important for survivors. Molecular markers: increasingly important for prognosis and treatment; MSI/dMMR testing standard. Sentinel lymph node: emerging standard for staging. Adjuvant therapy: low-risk may need observation only; intermediate-risk vaginal brachytherapy; high-risk chemotherapy +/- radiation. Fertility preservation: possible for select stage IA grade 1 with progestin therapy. Hormone replacement: generally safe for Type I after treatment; individualized decision. Surveillance: symptom-based with physical exam; imaging for symptoms. Lynch syndrome: screen all endometrial cancers; cascade testing for families. Exercise: beneficial for survivors; improves outcomes. Estrogen: protective factors include combined OCP use, multiparity, smoking (not recommended). Metformin: some observational data suggesting benefit; trials ongoing.

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