J Gynecol Oncol.  2015 Jul;26(3):227-231. 10.3802/jgo.2015.26.3.227.

Improving survival after endometrial cancer: the big picture

Affiliations
  • 1Division of Gynecologic Oncology, University of British Columbia and British Columbia Cancer Agency, Vancouver, BC, Canada. Janice.Kwon@vch.ca

Abstract

To improve survival in women with endometrial cancer, we need to look at the "big picture" beyond initial treatment. Although the majority of women will be diagnosed with early stage disease and are cured with surgery alone, there is a subgroup of women with advanced and high-risk early stage disease whose life expectancy may be prolonged with the addition of chemotherapy. Immunohistochemistry will help to identify those women with Lynch syndrome who will benefit from more frequent colorectal cancer surveillance and genetic counseling. If they happen to be diagnosed with colorectal cancer, this information has an important therapeutic implication. And finally, because the majority of women will survive their diagnosis of endometrial cancer, they remain at risk for breast and colorectal cancer, so these women should be counselled about screening for these cancers. These three interventions will contribute to improving the overall survival of women with endometrial cancer.

Keyword

Endometrial Neoplasms; Colorectal Neoplasms, Hereditary Nonpolyposis

MeSH Terms

Antineoplastic Agents/therapeutic use
Breast Neoplasms/diagnosis/mortality
Colorectal Neoplasms, Hereditary Nonpolyposis/diagnosis/mortality
Early Detection of Cancer
Endometrial Neoplasms/diagnosis/drug therapy/*mortality
Female
Humans
Life Expectancy
Risk Factors
Antineoplastic Agents

Reference

1. Kaaks R, Lukanova A, Kurzer MS. Obesity, endogenous hormones, and endometrial cancer risk: a synthetic review. Cancer Epidemiol Biomarkers Prev. 2002; 11:1531–1543.
2. Weiderpass E, Gridley G, Persson I, Nyren O, Ekbom A, Adami HO. Risk of endometrial and breast cancer in patients with diabetes mellitus. Int J Cancer. 1997; 71:360–363.
3. Shoff SM, Newcomb PA. Diabetes, body size, and risk of endometrial cancer. Am J Epidemiol. 1998; 148:234–240.
4. Parazzini F, La Vecchia C, Negri E, Riboldi GL, Surace M, Benzi G, et al. Diabetes and endometrial cancer: an Italian case-control study. Int J Cancer. 1999; 81:539–542.
5. Salazar-Martinez E, Lazcano-Ponce EC, Lira-Lira GG, Escudero-De los Rios P, Salmeron-Castro J, Larrea F, et al. Case-control study of diabetes, obesity, physical activity and risk of endometrial cancer among Mexican women. Cancer Causes Control. 2000; 11:707–711.
6. Friberg E, Orsini N, Mantzoros CS, Wolk A. Diabetes mellitus and risk of endometrial cancer: a meta-analysis. Diabetologia. 2007; 50:1365–1374.
7. Lucenteforte E, Bosetti C, Talamini R, Montella M, Zucchetto A, Pelucchi C, et al. Diabetes and endometrial cancer: effect modification by body weight, physical activity and hypertension. Br J Cancer. 2007; 97:995–998.
8. Lindemann K, Vatten LJ, Ellstrom-Engh M, Eskild A. Body mass, diabetes and smoking, and endometrial cancer risk: a follow-up study. Br J Cancer. 2008; 98:1582–1585.
9. Saltzman BS, Doherty JA, Hill DA, Beresford SA, Voigt LF, Chen C, et al. Diabetes and endometrial cancer: an evaluation of the modifying effects of other known risk factors. Am J Epidemiol. 2008; 167:607–614.
10. De Bruijn KM, Arends LR, Hansen BE, Leeflang S, Ruiter R, van Eijck CH. Systematic review and meta-analysis of the association between diabetes mellitus and incidence and mortality in breast and colorectal cancer. Br J Surg. 2013; 100:1421–1429.
11. Randall ME, Filiaci VL, Muss H, Spirtos NM, Mannel RS, Fowler J, et al. Randomized phase III trial of whole-abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol. 2006; 24:36–44.
12. Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer. 1987; 60:8 Suppl. 2035–2041.
13. Benedetti Panici P, Basile S, Maneschi F, Alberto Lissoni A, Signorelli M, Scambia G, et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst. 2008; 100:1707–1716.
14. ASTEC study group. Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009; 373:125–136.
15. Kosary CL. Cancer of the corpus uteri [Internet]. In : Ries LA, Young JL, Keel GE, Eisner MP, Lin YD, Horner MJ, editors. SEER survival monograph. Cancer survival among adults: U.S. SEER Program, 1988-2001, patient and tumor characteristics. Bethesda, MD: National Cancer Institute;2007. cited 2015 Jun 12. Available from: http://www.igcs.org/professionalEducation/treatmentResources/NCI_SEER2007/surv_corpus_uteri.pdf.
16. Hogberg T, Signorelli M, de Oliveira CF, Fossati R, Lissoni AA, Sorbe B, et al. Sequential adjuvant chemotherapy and radiotherapy in endometrial cancer: results from two randomised studies. Eur J Cancer. 2010; 46:2422–2431.
17. Susumu N, Sagae S, Udagawa Y, Niwa K, Kuramoto H, Satoh S, et al. Randomized phase III trial of pelvic radiotherapy versus cisplatin-based combined chemotherapy in patients with intermediate- and high-risk endometrial cancer: a Japanese Gynecologic Oncology Group study. Gynecol Oncol. 2008; 108:226–233.
18. Keys HM, Roberts JA, Brunetto VL, Zaino RJ, Spirtos NM, Bloss JD, et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2004; 92:744–751.
19. Kwon JS, Qiu F, Saskin R, Carey MS. Are uterine risk factors more important than nodal status in predicting survival in endometrial cancer? Obstet Gynecol. 2009; 114:736–743.
20. Nugent EK, Bishop EA, Mathews CA, Moxley KM, Tenney M, Mannel RS, et al. Do uterine risk factors or lymph node metastasis more significantly affect recurrence in patients with endometrioid adenocarcinoma? Gynecol Oncol. 2012; 125:94–98.
21. McMeekin DS, Filiaci VL, Aghajanian C, Cho J, Kim JW, DiSilvestro PA, et al. A randomized phase III trial of pelvic radiation therapy (PXRT) versus vaginal cuff brachytherapy followed by paclitaxel/carboplatin chemotherapy (VCB/C) in patients with high risk (HR), early stage endometrial cancer (EC): a Gynecologic Oncology Group trial. Gynecol Oncol. 2014; 134:438.
22. Jutzi L, Hoskins P, Lim P, Aquino-Parsons C, Tinker A, Kwon JS. The importance of adjuvant chemotherapy and pelvic radiotherapy in high-risk early stage endometrial carcinoma. Gynecol Oncol. 2013; 131:581–585.
23. van der Putten LJ, Hoskins P, Tinker A, Lim P, Aquino-Parsons C, Kwon JS. Population-based treatment and outcomes of stage I uterine serous carcinoma. Gynecol Oncol. 2014; 132:61–64.
24. Kwon JS, Mazgani M, Miller DM, Ehlen T, Heywood M, McAlpine JN, et al. The significance of surgical staging in intermediate-risk endometrial cancer. Gynecol Oncol. 2011; 122:50–54.
25. Lu KH, Broaddus RR. Gynecologic cancers in lynch syndrome/HNPCC. Fam Cancer. 2005; 4:249–254.
26. Lu KH, Dinh M, Kohlmann W, Watson P, Green J, Syngal S, et al. Gynecologic cancer as a "sentinel cancer" for women with hereditary nonpolyposis colorectal cancer syndrome. Obstet Gynecol. 2005; 105:569–574.
27. Broaddus RR, Lynch HT, Chen LM, Daniels MS, Conrad P, Munsell MF, et al. Pathologic features of endometrial carcinoma associated with HNPCC: a comparison with sporadic endometrial carcinoma. Cancer. 2006; 106:87–94.
28. Garg K, Soslow RA. Lynch syndrome (hereditary non-polyposis colorectal cancer) and endometrial carcinoma. J Clin Pathol. 2009; 62:679–684.
29. Westin SN, Lacour RA, Urbauer DL, Luthra R, Bodurka DC, Lu KH, et al. Carcinoma of the lower uterine segment: a newly described association with Lynch syndrome. J Clin Oncol. 2008; 26:5965–5971.
30. Hampel H, Frankel W, Panescu J, Lockman J, Sotamaa K, Fix D, et al. Screening for Lynch syndrome (hereditary nonpolyposis colorectal cancer) among endometrial cancer patients. Cancer Res. 2006; 66:7810–7817.
31. Mills AM, Liou S, Ford JM, Berek JS, Pai RK, Longacre TA. Lynch syndrome screening should be considered for all patients with newly diagnosed endometrial cancer. Am J Surg Pathol. 2014; 38:1501–1509.
32. Buchanan DD, Tan YY, Walsh MD, Clendenning M, Metcalf AM, Ferguson K, et al. Tumor mismatch repair immunohistochemistry and DNA MLH1 methylation testing of patients with endometrial cancer diagnosed at age younger than 60 years optimizes triage for population-level germline mismatch repair gene mutation testing. J Clin Oncol. 2014; 32:90–100.
33. Kwon JS, Scott JL, Gilks CB, Daniels MS, Sun CC, Lu KH. Testing women with endometrial cancer to detect Lynch syndrome. J Clin Oncol. 2011; 29:2247–2252.
34. Jarvinen HJ, Mecklin JP, Sistonen P. Screening reduces colorectal cancer rate in families with hereditary nonpolyposis colorectal cancer. Gastroenterology. 1995; 108:1405–1411.
35. Sargent DJ, Marsoni S, Monges G, Thibodeau SN, Labianca R, Hamilton SR, et al. Defective mismatch repair as a predictive marker for lack of efficacy of fluorouracil-based adjuvant therapy in colon cancer. J Clin Oncol. 2010; 28:3219–3226.
36. Ribic CM, Sargent DJ, Moore MJ, Thibodeau SN, French AJ, Goldberg RM, et al. Tumor microsatellite-instability status as a predictor of benefit from fluorouracil-based adjuvant chemotherapy for colon cancer. N Engl J Med. 2003; 349:247–257.
37. Bosetti C, Rosato V, Polesel J, Levi F, Talamini R, Montella M, et al. Diabetes mellitus and cancer risk in a network of case-control studies. Nutr Cancer. 2012; 64:643–651.
38. Larsson SC, Orsini N, Wolk A. Diabetes mellitus and risk of colorectal cancer: a meta-analysis. J Natl Cancer Inst. 2005; 97:1679–1687.
39. Schoen RE, Weissfeld JL, Kuller LH. Are women with breast, endometrial, or ovarian cancer at increased risk for colorectal cancer? Am J Gastroenterol. 1994; 89:835–842.
40. Weinberg DS, Newschaffer CJ, Topham A. Risk for colorectal cancer after gynecologic cancer. Ann Intern Med. 1999; 131:189–193.
41. Kwon JS, Elit L, Saskin R, Hodgson D, Grunfeld E. Secondary cancer prevention during follow-up for endometrial cancer. Obstet Gynecol. 2009; 113:790–795.
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