Feb. 28, 2025
Amid an upward trend in endometrial cancers (ECs), Mayo Clinic is pursuing a fast-track option for the evaluation and treatment of patients at high risk. In this article, Andrea Mariani, M.D., M.S., a gynecologic oncologist at Mayo Clinic in Rochester, Minnesota, who has spent a quarter century researching and treating this disease, and Shariska Harrington, M.D., a gynecologic oncologist at Mayo Clinic in Rochester, Minnesota, who is involved in research to improve outcomes of patients with EC, discuss endometrial cancer's status in the U.S. They also cover how Mayo Clinic will begin offering special services in 2025 for patients requiring rapid attention.
What is Mayo Clinic's fast-track care for patients with suspected or diagnosed EC?
Mayo Clinic in Minnesota's fast-track care will be available for patients with abnormal bleeding who are postmenopausal, especially those over age 60.
In the usual pathway, women experiencing abnormal bleeding see their primary healthcare professionals, followed by a gynecologist, and then have a biopsy. Every step in this process typically takes a few weeks, so by the time surgery is scheduled, 2 to 3 months have passed.
We annually see 1,500 patients age 45 and older with abnormal vaginal bleeding. We're working to expedite the appointment process, especially for women at higher risk, to enable prompt evaluation of abnormal bleeding concerns.
The target time frame for patients at high-risk to undergo a biopsy, receive pathology results and have surgery, as needed, is approximately 2 to 3 weeks. Surgery involves uterine removal and a sentinel lymph node (SLN) biopsy, providing diagnostic information regarding metastasis. Typically, 10% to 15% of patients who undergo SLN biopsy have EC-positive nodes.
Our pathology group's ability to routinely provide results within 48 to 72 hours accelerates this process. Also, frozen section with same-day results will be used at the discretion of the Gynecologic Oncology healthcare professional who performs the biopsy. Pathology with frozen section using a fast-track approach is rare in the U.S. At other medical centers, pathology results can take 1 to 2 weeks.
Why is a fast-track approach important?
Here are the key reasons for a fast-track approach:
- Significant high-grade EC volume. About one-third of EC is high grade — more aggressive — so early diagnosis and surgery are important for optimizing patient outcomes.
- Patient emotional health. It may be difficult for patients to wait weeks to complete all appointments to learn if EC is present.
- Patient satisfaction. Patients report higher satisfaction with their care when treated promptly.
What's unique about Mayo Clinic's EC approach?
Mayo Clinic's EC diagnosis and treatment distinctives include:
- Skilled surgeons who operate on a high volume of patients with EC.
- Pathologists who review a large volume of EC-related specimens with results available in 48 to 72 hours.
- Specialists in different aspects of EC diagnosis and care who regularly collaborate on individual patients' care and operate jointly.
Other features of Mayo Clinic's care for patients with suspected or diagnosed EC include:
- Attention to comfort. Mayo Clinic physicians are attentive to making all facets of EC diagnosis and treatment as comfortable as possible. For example, older patients are more likely to have an atrophic uterus or stenosis, which can increase biopsy discomfort. Therefore, we perform such endometrial biopsies under anesthesia to maximize comfort throughout the process.
- Addressing comorbidities. Patients with EC often have multiple comorbidities. For example, 80% of patients diagnosed with this cancer are overweight and 15% have obesity. Mayo Clinic gynecologic oncologists partner with endocrinologists and integrative medicine specialists to manage this comorbidity.
- A wellness approach. The wellness of our patients with EC is important. To address this need, Stacy D. D'Andre, M.D., a Mayo Clinic oncologist, uses integrative oncology focusing on diet, exercise and sleep. Addressing these areas helps patients during each part of their EC journeys. Dr. D'Andre's goal is to help people with cancer feel better by reducing fatigue, nausea, pain, anxiety and other symptoms that can accompany cancer and its treatment.
Do you offer robotic surgery?
Yes. A robotic approach is the most appropriate and commonly used EC surgical approach, and Mayo Clinic is a high-volume robotic surgery center. Robotic surgery is especially advantageous for overweight patients because it increases the surgeon's visualization, range of motion and accuracy.
What occurs immediately following surgery?
Our patients often go home on the day of surgery. If they're from out of town, they usually stay in a hotel or an assisted living facility close to Mayo Clinic's hospitals.
Is Mayo Clinic conducting clinical or laboratory EC research?
Mayo Clinic in Minnesota has numerous EC clinical trials, including a significant number for advanced, high-risk or recurrent EC, some of which involve immunotherapy. Our medical center's investigators are researching early EC detection and interception. We also are investigating risk stratification for distinct ECs and using artificial intelligence, especially in pathology and imaging, for this cancer.
What do you recommend to physicians who have patients with suspected or diagnosed EC?
We recommend referring patients with atypical endometrial hyperplasia and those diagnosed with EC to a medical center that treats large numbers of patients with this cancer. Patients with advanced disease require an experienced center with high-level expertise. Mayo Clinic in Minnesota has healthcare professionals with this level of expertise and is a high-volume center for EC diagnosis and treatment.
If I refer my patients to Mayo Clinic, will they undergo a biopsy? If so, what is the likelihood of the biopsy being positive for EC or atypical hyperplasia (AH)?
After consultation with a member of our minimally invasive gynecologic surgery team, about one-half of patients undergo a biopsy. Of those biopsied, about 10% to 13% — close to 1 out of 10 — have EC or AH.
Here are the percentages of EC and AH that Mayo Clinic in Minnesota professionals discover in patients who undergo biopsy, by age group:
- Ages 45 to 55. EC and AH are uncommon in patients we see who are younger than age 55. We find that only 4% have EC or AH.
- Ages 55 to 60. We find that 8% have EC or AH.
- Age 60 and older. In this age group, we found that 26% — about 1 in 4 — patients have EC or AH in our institution.
How should I refer a patient to Mayo Clinic in Minnesota?
If you've diagnosed a patient with EC postbiopsy, or if suspicion for EC is high and requires a biopsy, you can refer the patient to Mayo Clinic by phone, by fax or through CareLink.
Mayo Clinic and its hospitals are in-network for many insurance plans. Our medical center recommends that you encourage patients to contact their insurance providers to verify benefits and eligibility for services provided by Mayo Clinic.
What do you consider the key factors in diagnosing EC?
Often a patient's experience of postmenopausal bleeding — a common reason for seeking medical attention — leads to a diagnosis.
After the completion of menses, it's not normal to see blood. It can be emanating from the urine, rectum, vagina or uterus. It's crucial for people to seek medical attention if they notice blood — even if it's minor spotting — and for their physicians to see them promptly.
At ages 50 to 55, women may have irregular bleeding because they are still transitioning to menopause. In older patients, however, it's more likely there's a medical condition.
Women age 55 and older and their healthcare professionals should not dismiss any abnormal bleeding.
How does EC compare with other cancers in U.S. women?
EC is the most common genital tract malignancy for U.S. women. It ranks fourth in cancer frequency for women overall. By 2030, EC rates are projected to surpass colon cancer and become the third most common female cancer.
About two-thirds of ECs are low grade, and patients do well with treatment. For example, the cure rate is 70% for women with grade 1, stage 1 EC. Patients diagnosed with advanced or high-grade EC, however, need more attention. For women with stage 4 EC, the cure rate at five years following diagnosis is less than 30%.
For more information
Mayo Clinic CareLink
Refer a patient to Mayo Clinic.