From the Guidelines
The prognosis for uterine cancer is highly dependent on the stage at diagnosis, with early-stage disease having a 5-year overall survival rate of 77%-90% for Stage I, according to the most recent evidence 1.
Treatment Approach
The treatment for uterine cancer typically begins with surgery, including hysterectomy and bilateral salpingo-oophorectomy to remove the uterus, cervix, fallopian tubes, and ovaries. Lymph node sampling may also be performed.
- For early-stage disease (Stage I-II), surgery alone may be sufficient, as indicated in the guidelines for adjuvant treatment 1.
- More advanced cases often require adjuvant therapy such as radiation (external beam and/or vaginal brachytherapy), chemotherapy (commonly carboplatin and paclitaxel), or a combination of both.
Adjuvant Therapy
The choice of adjuvant therapy depends on the stage and grade of the disease, as well as the presence of negative prognostic factors.
- For Stage III-IV disease, chemotherapy is recommended, with sequential radiotherapy for patients with positive nodes 1.
- Platinum-based adjuvant chemotherapy has been shown to improve progression-free survival and overall survival in patients with early-stage disease 1.
Immunotherapy
For recurrent or metastatic disease, immunotherapy with pembrolizumab may be an option, particularly for MSI-high tumors, as suggested by recent guidelines on immunotherapy for gynecologic cancer 1.
Follow-up
Regular follow-up is essential, typically every 3-6 months for the first 2-3 years, to monitor for recurrence and manage any symptoms or side effects of treatment.
Individualized Approach
The treatment approach is individualized based on cancer stage, grade, histologic type, patient age, and overall health status, emphasizing the importance of personalized medicine in uterine cancer treatment.
- Early detection significantly improves outcomes, making prompt attention to symptoms like abnormal vaginal bleeding crucial, as highlighted in the recent clinical practice guidelines 1.
From the Research
Uterine Cancer Prognosis and Treatment
The prognosis and treatment of uterine cancer depend on various factors, including the stage and type of cancer.
- Uterine serous carcinoma (USC) is a type of uterine cancer that has a poor prognosis, especially in advanced stages 2.
- A study found that patients with early-stage USC have a 2-year survival probability of 0.96 and a 5-year survival probability of 0.81, while those with late-stage USC have a 2-year survival probability of 0.64 and a 5-year survival probability of 0.18 2.
- Lymphovascular invasion (LVSI) is a significant poor prognostic factor in stage I USC, with a 2.7 times higher risk of death than those without LVSI 2.
Treatment Options
- Adjuvant pelvic radiation "sandwiched" between paclitaxel/carboplatin chemotherapy is an effective treatment approach for USC, with acceptable toxicities 2.
- Chemotherapy and radiation therapy can improve survival in patients with advanced-stage uterine clear cell carcinoma (UCCC) 3.
- Paclitaxel and platinum-based chemotherapy has demonstrated activity in uterine papillary serous carcinoma (UPSC) with acceptable toxicity 4, 5.
- Radiation therapy can improve relapse-free survival (RFS) in patients with UPSC, with few grade 3 or higher complications 5.
Prognostic Factors
- FIGO stage, depth of myometrial invasion, and complete cytoreduction are significantly associated with disease-free survival (DFS) in uterine sarcoma 6.
- Menopausal status, FIGO stage, depth of myometrial invasion, and lymph-vascular space invasion (LVSI) are significantly associated with overall survival (OS) in uterine sarcoma 6.
- Increasing age, stage, and myometrial invasion are prognostic factors associated with shorter OS and RFS in UPSC 5.