Endometrial cancer natural history
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shankar Kumar, M.B.B.S. [2]]
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Overview
Natural History
Complications
Complications are usually due to the therapy. They can be classified as -
- Intra-operative-
- Uterine perforation following D&C or biopsy.
- Hemorrhage after lymphadenectomy
- Post-operative- typically common as many females have comorbid conditions like obesity, increased age, etc when they develop endometrial cancer. Of note is thromboembolism.
Prognosis
Of all prognostic factors to consider in endometrial cancer, staging is the most important one. Surgical histopathology contributes to it. Clear cell and papillary serous types are associated with a poor prognosis and are included in the histological category of poorly differentiated variety. As far as squamous types are concerned, it is just the adeno component which plays a key role in prognosis. More the adeno component, worse the prognosis.
It is the depth and not the grade of myometrial invasion that is important, as with increasing depth, there are high chances of extra-uterine spread. Lymph node metastasis is equally important and must be correlated with other prognostic factors. A positive peritoneal cytology needs only to be reported but it does not change the stage.
Because endometrial cancer is usually diagnosed in the early stages (70 % to 75 % of cases are in stage 1 at diagnosis; 10 % to 15 % of cases are in stage 2; 10 % to 15 % of cases are in stage 3 or 4), there is a better probable outcome associated with it than with other types of gynecological cancers such as cervical or ovarian cancer. While endometrial cancers are 40% more common in Caucasian women, an African American woman who is diagnosed with uterine cancer is twice as likely to die, possibly due to the higher frequency of aggressive subtypes in that population.
Survival rates
The 5-year survival rate for endometrial cancer following appropriate treatment is:
- 75% to 95% for stage 1
- 50% for stage 2
- 30% for stage 3
- less than 5% for stage 4
References
complications and prognosis