Uterine Cancer
Summary of Key Points
Adjuvant Therapy
• Risk factors for recurrence or extrauterine spread include deep myometrial invasion, moderate- to high-grade histology, and lymphovascular space invasion (LVSI)
• Adjuvant radiation may be used in patients with high-intermediate and high-risk disease
• Adjuvant chemotherapy with or without radiation therapy may be administered in cases with aggressive histology, such as serous, clear cell, carcinosarcoma, or leiomyosarcoma and undifferentiated endometrial sarcoma
Locally Advanced, Metastatic, or Recurrent Disease
• Chemotherapy, radiation, or combination therapy is used in locally advanced, metastatic, or recurrent endometrial cancer
• Cytoreductive surgery is associated with improved overall survival
• Salvage radiotherapy is utilized for recurrences after surgery alone
• Endocrine therapy with progestins and/or tamoxifen may be used when avoidance of cytotoxic chemotherapy is desired
• Tumor-directed radiation therapy may be employed in cases of locally advanced, metastatic, or recurrent disease
1. Which of the following is associated with an increased risk of endometrial carcinoma?
2. Adjuvant radiotherapy is associated with which of the following?
A Improved overall survival for patients with stage I and II disease
B Improved overall survival for patients with high-intermediate risk disease
C Improved locoregional control with fewer vaginal cuff recurrences
D Radiation therapy is not recommended for adjuvant treatment of endometrial cancer
3. Which of the following is true regarding treatment of uterine sarcomas?
A Hormonal therapy is an effective treatment for uterine sarcoma
B Adjuvant radiation has been shown to improve overall survival and local recurrence rates
C Endometrial stromal sarcoma (ESS) is an indolent tumor that responds well to hormonal treatment
D Leiomyosarcoma is an indolent tumor that responds well to hormonal treatment and chemotherapy
1. Answer: B. Obesity is associated with an increased risk of endometrial carcinoma. HPV has not been associated with endometrial cancer. Oral contraceptives decrease the risk of endometrial cancer. Radiation therapy has been associated with uterine sarcoma but not endometrial carcinomas.
2. Answer: C. Adjuvant therapy decreases local recurrence rates but has not shown improvements in overall survival.
3. Answer: C. Hormonal therapy has been shown to be effective in ESS, but not undifferentiated endometrial sarcoma or leiomyosarcoma. Adjuvant radiation has not been shown to improve survival and may not decrease local recurrence rates.
