Endometrial Cancer: Patient Presentation and Initial Workup


Expert perspective on the presentation of endometrial cancer, followed by advice on providing optimal workup and diagnosis.


Bhavana Pothuri, MD: The typical patient that we see with endometrial cancer is obese, hypertensive, and usually has a well differentiated or grade 1 endometrioid histology. Since I'm in New York City, I also see a very racially and ethnically diverse patient population and many of these patients unfortunately present with more advanced-stage disease and more of the higher risk histologic subtypes, such as uterine serous cancer.

Typically about a quarter to a third of patients have mismatch repair deficiency. I recommend all patients with endometrial cancer have mismatch repair testing. In my practice, our pathologists routinely test for mismatch repair deficiency by immunohistochemistry [IHC] for MLH1, MSH2, MSH6 and PMS2. And if MLH1 is absent on immunohistochemistry, they reflexively get tested for MLH1 hypermethylation. In terms of other molecular testing, if your mismatch repair IHC is intact you can consider MSI [microsatellite instability] testing for completeness sake and so that you don't miss any patients.

Transcript edited for clarity.

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