From ultrasound to molecular diagnostics: a modern approach to endometrial cancer treatment.
Endometrial cancer diagnosis is no longer limited to transvaginal ultrasound. Today, a combination of histopathological and molecular testing allows for precise diagnosis of the tumor's nature and the selection of therapy, significantly improving patient prognosis.
Transvaginal ultrasound remains a fundamental tool for detecting endometrial lesions. However, the image alone is insufficient for a complete diagnosis of endometrial cancer. Ultrasound can only signal a worrisome lesion, while the true information lies in the tumor's characteristics. Endometrial cancer is not a single disease, but a group of tumors with distinct biology, which is crucial for prognosis.
Endometrial cancer is one of the cancers whose mortality rate has been increasing by an average of 5% per year over the last two decades.
Not every abnormal bleeding or spotting between periods necessarily indicates endometrial cancer. However, any such abnormality, especially if recurring, requires consultation with a doctor, as it may indicate other gynecological problems. If you are postmenopausal and experience bleeding, don't wait. Schedule an ultrasound with your gynecologist," urges Pola Król, president of the Życie z Rakiem Oncological Foundation.
Early ultrasound allows for quick identification of changes and referral of the patient for further tests.
Patients should remember that abnormal endometrial appearance isn't always a cause for concern – it can be a physiological response to the menstrual cycle. It's not cancer, but a disturbing symptom that shouldn't be ignored. However, endometrial hyperplasia, especially in postmenopausal women, is a condition that requires diagnosis," explains Prof. Anita Chudecka-Głaz, MD, PhD. "Untreated hyperplasia can lead to endometrial cancer, which is one of the most common malignancies in women," she adds.
Endometrial hyperplasia results from hormonal imbalances, where excess estrogen combined with low levels of progestogens leads to irregular growth of the endometrial glands. A doctor diagnoses it with an ultrasound, assessing, among other things, the thickness of the endometrium. A distinction is made between hyperplasia without atypia, which carries a lower risk of cancer, and hyperplasia with atypia, which can develop into cancer.
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Abnormalities detected by ultrasound are confirmed by histopathological examination, followed by molecular diagnostics and analysis of postoperative material . Based on all the data, the doctor classifies the tumor according to the FIGO scale. Over the past few years, molecular diagnostics has become an indispensable element in the evaluation of endometrial cancer, transforming the approach to treatment.
Molecular diagnostics aren't an afterthought; they're essential. Every day, we encounter patients struggling to understand the test results they receive. They want to know what the molecular type of their cancer means and what treatment options they have. Immunohistochemical tests and genetic profiling should be performed routinely, right from the diagnosis stage. Only then can therapy be implemented that is tailored to the cancer's biology, not just to obtain details about its location or size," says Pola Król.
A breakthrough in the treatment of endometrial cancer occurred in 2013, when the molecular types of the cancer were formally identified. It is now known that endometrial cancer is a group of tumors with distinct biological characteristics, enabling the development of more effective therapies.
DNA repair mechanism (MMR) status is crucial. Patients are divided into dMMR (DNA repair deficient), who respond better to immunotherapy, and non-dMMR/pMMR, which are tumors less responsive to immunotherapy.
Every patient, regardless of the molecular type of cancer, should have equal access to effective treatment. We are currently awaiting the Ministry of Health's decision regarding the expansion of the drug program for endometrial cancer patients belonging to the pMMR group. The decision is expected in October," emphasizes Prof. Anita Chudecka-Głaz, MD, PhD.
Currently, knowledge of the tumor's molecular type is crucial for selecting effective therapy. We are delighted with the changes being introduced in the B.148 drug program, which gives patients with 'warm' dMMR tumors access to groundbreaking immunotherapy, which delivers excellent results and even long-lasting responses. We also believe that a larger group of patients with 'cold' non-dMMR tumors will soon have their chance. By adding a PARP inhibitor to immunotherapy, it has become possible to 'warm up' the tumor, making it more susceptible to the immune system. Therefore, we look forward to accessing combination therapy, which provides the longest response to treatment," concludes Pola Król.
Endometrial cancer manifests itself through abnormal bleeding, so it's important to monitor your health and get regular checkups. Advances in molecular diagnostics allow for precise therapy selection, resulting in more effective treatment and improved patient outcomes.
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Source: Life with Cancer Foundation
Source: Life with Cancer Foundation Updated: 29/08/2025 18:15
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