Appointment sheet
Endometrial cancer with no specific molecular profile
Prepared with OnCo (onco.cc/prep/endometrial-nsmp/). Orientation, not medical advice; your team knows your case.
My details
Name
Date of appointment
Hospital and clinician
Who is coming with me
What I know, what is unclear, changes to discuss
Saved in this browserWhat I know so far
What is unclear to me
Changes since last time
My questions
21 on the sheetNewly diagnosed
- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.Which biomarkers have been tested on my tumour (for example Negative POLE, MMR and p53 results, Oestrogen and progesterone receptor expression, L1CAM expression, CTNNB1 exon 3 mutation, Grade, depth of invasion and lymphovascular space invasion), and what were the results?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
Low risk (stage IA grade 1 to 2, no substantial LVSI)
- 5.For my situation (low risk (stage ia grade 1 to 2, no substantial lvsi)), which of the standard options do you recommend and why?
- 6.How do the results of FIRES & SENTOR (sentinel node mapping) apply to someone like me?
Intermediate and high-intermediate risk
- 7.For my situation (intermediate and high-intermediate risk), which of the standard options do you recommend and why?
- 8.How do the results of PORTEC-3 apply to someone like me?
Fertility-sparing (grade 1, stage IA, no invasion)
- 9.For my situation (fertility-sparing (grade 1, stage ia, no invasion)), which of the standard options do you recommend and why?
- 10.Am I a candidate for Progestins (megestrol acetate, medroxyprogesterone, levonorgestrel IUD), and what side effects should I expect?
Advanced or recurrent, first line
- 11.For my situation (advanced or recurrent, first line), which of the standard options do you recommend and why?
- 12.Am I a candidate for Carboplatin, Paclitaxel / nab-paclitaxel, Pembrolizumab or related drugs, and what side effects should I expect?
- 13.How do the results of NRG-GY018 / KEYNOTE-868 and RUBY / ENGOT-EN6 / GOG-3031 apply to someone like me?
After platinum
- 14.For my situation (after platinum), which of the standard options do you recommend and why?
- 15.Am I a candidate for Lenvatinib, Pembrolizumab, Letrozole (and other aromatase inhibitors) or related drugs, and what side effects should I expect?
- 16.How do the results of KEYNOTE-775 / Study 309 apply to someone like me?
Any stage
- 17.Are there clinical trials I could join, for example of Abemaciclib, Letrozole (and other aromatase inhibitors), Molecular-class-directed adjuvant therapy in endometrial cancer, XPORT-EC-042 / ENGOT-EN20 / GOG-3083?
- 18.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 19.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 20.I read that “Splitting the class into truly low-risk and higher-risk tumours with L1CAM, CTNNB1 and receptor status”. How does that affect my plan?
- 21.I read that “Whether progestins can replace chemotherapy after surgery”. How does that affect my plan?
The words I may hear
- Microsatellite-stable (MSS) / mismatch-repair proficient (pMMR): The 'normal' result on the mismatch-repair test: the tumour has intact DNA spell-checking and few mutations.
- Endometrial cancer molecular classes (POLEmut, MMRd, p53abn, NSMP): Four groups defined by a few tests that predict outcome better than the microscope: POLE-mutated (excellent), mismatch-repair deficient, p53-abnormal (worst), and 'no specific profile'.
- Hysterectomy: Removing the uterus (womb), often with the cervix, tubes and ovaries.
Tests and results to bring
Biomarker results to ask for: Negative POLE, MMR and p53 results (diagnosis by exclusion), Oestrogen and progesterone receptor expression, L1CAM expression, CTNNB1 exon 3 mutation, Grade, depth of invasion and lymphovascular space invasion, PTEN, PIK3CA and ARID1A mutations.
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Low risk (stage IA grade 1 to 2, no substantial LVSI): Hysterectomy with bilateral salpingo-oophorectomy and sentinel node mapping; no adjuvant treatment. (Hysterectomy, Sentinel lymph node biopsy, FIRES & SENTOR (sentinel node mapping), Robotic & minimally invasive surgery, Endometrial cancer molecular classes (POLEmut, MMRd, p53abn, NSMP))
- Intermediate and high-intermediate risk: Vaginal brachytherapy (PORTEC-2) or pelvic radiotherapy; chemotherapy adds little in this class. (Brachytherapy, IMRT / IGRT (modern external beam), PORTEC-3)
- Fertility-sparing (grade 1, stage IA, no invasion): Levonorgestrel intrauterine device or oral progestin with hysteroscopic sampling every three to six months; hysterectomy after childbearing. (Fertility-sparing hormonal treatment of early endometrial cancer, Progestins (megestrol acetate, medroxyprogesterone, levonorgestrel IUD))
- Advanced or recurrent, first line: Carboplatin-paclitaxel with pembrolizumab or dostarlimab (smaller benefit than in dMMR); endocrine therapy for low-grade receptor-positive disease. (Carboplatin, Paclitaxel / nab-paclitaxel, Pembrolizumab, Dostarlimab, NRG-GY018 / KEYNOTE-868, RUBY / ENGOT-EN6 / GOG-3031, Letrozole (and other aromatase inhibitors), Progestins (megestrol acetate, medroxyprogesterone, levonorgestrel IUD), Microsatellite-stable (MSS) / mismatch-repair proficient (pMMR))
- After platinum: Lenvatinib with pembrolizumab (KEYNOTE-775); aromatase inhibitor with or without a CDK4/6 inhibitor in receptor-positive disease. (Lenvatinib, Pembrolizumab, KEYNOTE-775 / Study 309, Letrozole (and other aromatase inhibitors), Abemaciclib)
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.
Answers and next steps
Saved in this browserWhat I was told
Agreed next steps, dates and who to call