Is there a serous (serous) uterine cancer, specifically serous endometrial carcinoma?

From the Guidelines

Yes, there is a type of uterine cancer called serous uterine carcinoma, also known as uterine serous carcinoma or USC, which is an aggressive subtype of endometrial cancer. This cancer accounts for about 10-15% of all uterine cancers and is responsible for a disproportionate number of endometrial cancer deaths due to its aggressive nature 1. Serous uterine cancer typically affects older women, often in their 60s or 70s, and may present with symptoms such as abnormal vaginal bleeding, pelvic pain, or a feeling of pressure in the pelvic area.

Key Characteristics of Serous Uterine Carcinoma

• It is an aggressive subtype of endometrial cancer with a high risk of recurrence and metastasis 1.
• It often presents at an advanced stage, with 70% of cases having already spread outside the uterus at the time of presentation 1.
• The molecular profile of serous uterine carcinoma differs from more common endometrial cancers, with frequent p53 mutations and less association with estrogen exposure than other types of endometrial cancer 1.

Treatment Approaches

• Treatment usually involves a multimodal approach including surgery (hysterectomy with bilateral salpingo-oophorectomy), chemotherapy, and sometimes radiation therapy 1.
• The use of predictive biomarkers, such as p53 or L1 cell adhesion molecule (L1CAM), is promising but remains investigational 1.
• Platinum-based adjuvant chemotherapy is recommended in patients with stage III or IV serous uterine carcinoma 1.

Prognosis and Outcomes

• The 5-year overall survival (OS) rate for patients with uterine serous cancer is 20%–25% versus 80% for all patients with endometrial cancer 1.
• The prognosis for serous uterine carcinoma is generally poor due to its aggressive nature and high risk of recurrence and metastasis 1.

From the Research

Uterine Serous Carcinoma

• Uterine serous carcinoma (USC) is a highly aggressive variant of endometrial cancer, accounting for a disproportionate number of deaths from endometrial cancer 2, 3.
• It is characterized by a high propensity for locoregional and distant spread, and tends to be more advanced at presentation, carrying a higher risk of recurrence and death than endometrioid cancers 2.
• The primary treatment for non-metastatic uterine serous carcinomas is complete surgical staging, with total hysterectomy, salpingo-oophorectomy, omentectomy, and lymph node staging 2, 4.

Diagnosis and Treatment

• Systematic surgical staging is necessary before additional therapy is recommended, and stage I uterine papillary serous cancer requires aggressive treatment, including surgery, chemotherapy, and radiation therapy for successful treatment 4.
• Comprehensive surgical staging followed by carboplatin and paclitaxel chemotherapy represents the mainstay of USC therapy, and vaginal cuff brachytherapy is also of potential benefit in USC 3.
• Adjuvant chemotherapy has been shown to improve overall survival and progression-free survival in women with USC, even in those with early-stage disease 5.

Prognosis and Recurrence

• Women with USC have a high recurrence rate, even in surgically staged women with FIGO stage IA disease, and distant recurrence is common 5.
• The benefit of adjuvant chemotherapy is observed across all tumor stages, including surgically staged FIGO stage IA, and questions the role of surgical staging in the absence of macroscopic disease in USC 5.
• Molecularly targeted therapies are being introduced into the management of USC, targeting novel therapeutic targets such as HER2/NEU, PIK3CA/AKT/mTOR, and cyclin E/FBXW7 oncogenic pathways 3.