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Endometrial Cancer Treatment (PDQ®)

Changes to This Summary (04/23/2014)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

General Information About Endometrial Cancer

Updated statistics with estimated new cases and deaths for 2014 (cited American Cancer Society as reference 1).

Revised text to state that irregular vaginal bleeding is an early sign, the foremost symptom, and the reason why the majority of patients with the highly curable endometrial tumor are diagnosed with stage I disease.

Added text to state that risk factors for the development of endometrial cancer include obesity, hypertension, and diabetes mellitus.

Added text to state that cardiovascular disease is the most common cause of death in patients diagnosed with endometrial cancer because of the early stage of the cancer at diagnosis and the metabolic risk factors (cited Ward et al. as reference 2).

Cellular Classification of Endometrial Cancer

Added text to state that endometrial cancers are classified in one of two categories; namely, type 1 may arise from complex atypical hyperplasia and is pathogenetically linked to unopposed estrogenic stimulation; type 2 develops from atrophic endometrium and is not linked to hormonally driven pathogenesis.

Added text to state that characteristic activating oncogenic mutations or amplification and inactivating mutations or deletion of tumor suppressors are seen more in association with one type of mutation versus the other type, but some overlap exists. Also added that with the Cancer Genome Atlas and a full genetic display of hundreds of endometrial cancers, four subtypes have been identified that will refine classification and provide prognostic and therapeutic implications (cited Kandoth et al. as reference 1).

Stage Information for Endometrial Cancer

Added text to state that even if it no longer influences staging, retrospective data based on the Surveillance, Epidemiology, and End Results Program suggest that positive peritoneal cytology is an independent risk factor in patients with early-stage endometrial cancer (cited Garg et al. as reference 3).

Stage I Endometrial Cancer

Added text to state that uterine serous histologies have higher rates of recurrence than do other stage I endometrioid carcinomas; the outcomes in institutional case series that utilize a policy of adjuvant carboplatin plus paclitaxel, occasionally including radiation therapy, for this histologic subtype, have been published and form the basis of management guidelines (cited Kiess et al., Boruta et al., Huh et al., Fader et al., Kelly et al., Havrilesky et al., and Dietrich et al., as references 1, 2, 3, 4, 5, 6, and 7, respectively). Also added that the Gynecologic Oncology Group (GOG-0249 [NCT00807768]) trial is comparing this chemotherapy regimen to pelvic radiation.

Added Kong et al. as reference 14.

Revised text to state that there were significantly fewer gastrointestinal toxic effects and significantly improved quality of life in the vaginal brachytherapy (VBT) group, making VBT the preferred option for adjuvant treatment of patients with stage I disease (cited Nout et al. as reference 19).

Added text to state that a Cochrane Review of the use of laparoscopic staging included four randomized controlled trials that reported overall survival (OS) and progression-free survival (PFS), although 90% of the patients were from the GOG-Lamina-associated polypeptide 2 (GOG-LAP2) trial; laparoscopy was associated with similar OS and PFS rates when it was compared with laparotomy (cited Galaal et al. as reference 27 and level of evidence 1iiA).

Stage II Endometrial Cancer

Added text to state that uterine serous histologies have higher rates of recurrence than do other stage II endometrioid carcinomas. Also added that the outcomes in institutional case series that utilize a policy of adjuvant carboplatin plus paclitaxel, occasionally including radiation therapy for this histologic subtype have been published and form the basis of management guidelines (cited Kiess et al. and Fader et al. as references 1 and 2). The GOG-0249 (NCT00807768) trial is comparing this chemotherapy regimen to pelvic radiation.

Stage IV Endometrial Cancer

Added text to state that biologic agents under evaluation for patients with advanced and recurrent endometrial cancer include bevacizumab, which was given as a single agent in a phase II trial with an overall response of 13.5% (cited Aghajanian et al. as reference 11) and bevacizumab and temsirolimus (cited Alvarez et al. as reference 12).

Recurrent Endometrial Cancer

Added text to state that biologic agents under evaluation for patients with advanced and recurrent endometrial cancer include bevacizumab, which was given as a single agent in a phase II trial with an overall response of 13.5% (cited Aghajanian et al. as reference 8), and bevacizumab and temsirolimus (cited Alvarez et al. as reference 9).

This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.

  • Updated: April 23, 2014