Endometrial cancer natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Natural history
- Endometrial cancer forms when there are errors in normal endometrial cell growth. Usually, when cells grow old or get damaged, they die, and new cells take their place.Cancer starts when new cells form unneeded, and old or damaged cells do not die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor.
- It is a multistep process that involves genetics, abnormalities of cell regulation, and environmental triggers
- Patient has early symptoms like,abnormal uterine bleeding, abnormal menstrual periods, bleeding between normal periods in premenopausal women.Vaginal bleeding and/or spotting in postmenopausal women
- As the tumor grows larger, patient may notice symptoms like, trouble urinating, pelvic pain and pain during intercourse
- If the diseases advances and spreads to other organs, the patient may present with dyspnea, cough with blood-stained sputum, persistent pain or discomfort in the chest, swelling in hands/feet, itchiness, jaundice, and/or dark-colored urine
- Once the cancer spreads to the other organs, it is most likely fatal
Complications
- A perforation (hole) of the uterus may occur during a D&C or an endometrial biopsy.
Prognosis
Another factor found to correlate with extrauterine and nodal spread of tumor is involvement of the capillary-lymphatic space on histopathologic examination. Three prognostic groupings of clinical stage I disease become possible by careful operative staging.
- Patients with grade 1 tumors involving only endometrium and no evidence of intraperitoneal disease (i.e., adnexal spread) have a low risk (<5%) of nodal involvement.
- Patients with grade 2 or 3 tumors and invasion of less than 50% of the myometrium and no intraperitoneal disease have a 5% to 9% incidence of pelvic node involvement and a 4% incidence of positive para-aortic nodes.
- Patients with deep muscle invasion and high-grade tumors and/or intraperitoneal disease have a significant risk of nodal spread, 20% to 60% to pelvic nodes and 10% to 30% to para-aortic nodes.
The following four are statistically significant adverse prognostic factors:
- Myometrial invasion.
- Vascular invasion.
- Eight or more mitoses per ten high-power fields.
- An absence of progesterone receptors.
- Based on Gynecologic Oncology Group (GOG) study following are the other prognostic indicators of clinical outcome
- Oncogene expression.
- DNA ploidy.
- The fraction of cells in S-phase.
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