Uterine papillary serous carcinoma: a review

Distribution and volume of extrauterine disease in uterine serous carcinoma: is minimally invasive surgery a suitable approach?

OBJECTIVE

Minimally invasive surgery (MIS) is the preferred technique for managing endometrial cancer. Given that uterine serous carcinoma (USC) has a predilection for multiquadrant peritoneal dissemination, our objective was to estimate the potential risk for overlooking occult peritoneal spread with the use of MIS.

METHODS

A single-institution, retrospective review was conducted of patients who underwent primary surgical staging for endometrial cancer via laparotomy between 1999 and 2008. Patterns of metastases were analyzed to estimate the potential risk for understaging via MIS.

RESULTS

A total of 202 USC cases met inclusion criteria. Pelvic and para-aortic nodes were positive in 59 (36%) of 166 and 43 (31%) of 138, respectively. Stage IVb disease was diagnosed in 77 (38%) of 202 patients. The majority (86%, 66/77) harbored bulky and/or multisite macroscopic abdominal implants. Isolated microscopic peritoneal disease was present in 5 of 77 cases (6% of stage IV, 2% of the entire cohort) but, in all cases, was limited to the omentum; 6 of 77 cases (8% of stage IV, 3% of the cohort) harbored a single implant in the context of a negative omentum but, in all cases, were macroscopic (locations included the ileum, the diaphragm, and the base of the mesentery).

CONCLUSIONS

For providers who aim to remove all visible disease in patients with USC, the rate of extrauterine disease escaping detection using MIS is low (<3%) provided an omentectomy is performed together with staging.

The frequency and significance of WT-1 expression in serous endometrial carcinoma

Serous endometrial carcinoma is an aggressive type of endometrial carcinoma. Wilms tumor gene 1 (WT-1) is commonly expressed in ovarian serous carcinomas and considered a diagnostic marker of these tumors. However, it is generally believed that WT-1 is rarely expressed by endometrial serous carcinoma. The aim of this study was to evaluate the frequency and significance of WT-1 expression in endometrial serous carcinoma. We studied the expression of WT-1 in formalin-fixed, paraffin-embedded tumor sections from 77 cases of endometrial serous carcinoma. Thirty-four tumors showed positive expression for WT-1 (44%). There was a statistically significant association between the presence of WT-1 expression and disease-free survival (DFS), where patients with tumors expressing WT-1 had a shorter DFS compared with those with no WT-1 expression (P = .031; median DFS, 15 and 38 months, respectively). By multivariate Cox regression analysis, DFS was independent from other clinicopathological data (tumor stage, presence of lymphovascular space invasion, cervical involvement, and extrauterine spread), indicating that WT-1 expression is independently associated with DFS. Our study shows that WT-1 is expressed in a considerable percentage of endometrial serous carcinomas, suggesting a role for WT-1 in the pathology of these tumors. This has therapeutic significance, as WT-1 is an emerging target for immunotherapy. Moreover, our results show that WT-1 has prognostic value, being predictive of DFS. As a potential prognostic marker and therapeutic target, we recommend that WT-1 expression should be included in histopathologic reports of endometrial serous carcinoma.

Abdominal wall metastasis of uterine papillary serous carcinoma in a post-menopausal woman: a case report

Uterine papillary serous carcinoma (UPSC) is an aggressive form of endometrial cancer characterized by a high recurrence rate and poor prognosis. We report a case of a 58-year-old post-menopausal woman with an abdominal wall metastasis in stage IA UPSC. After surgical staging, she did not receive additional adjuvant therapy. An egg sized palpable mass developed in the right lower abdomen after 8 months. Both Abdominopelvic computed tomography (CT) and positron emission tomography (PET)-CT revealed a metastatic lesion in the abdominal wall. Hence, surgical excision was performed. The pathological findings showed metastatic UPSC with clear resection margin. After the diagnosis of UPSC metastasis in the abdominal wall, she received chemotherapy utilizing paclitaxel and carboplatin. After 3 years, no evidence of recurrence was found. Therefore, we suggest that even when UPSC is confined to the endometrium without lymph node metastasis and without lymphovascular invasion, chemotherapy should be considered as a postoperative adjuvant therapy.

Management of women with surgically staged 1 uterine papillary serous cancer

Objective. To review the management and outcomes of women with surgically staged 1 UPSC. Methods. We report on a case series from 2008-2010 from Hamilton Canada. We summarize the data from a literature search on surgically staged 1 UPSC. Results. There is a group women with Stage 1A UPSC with no residual disease at time of surgery who do not require adjuvant therapy. Vault recurrences appear to be lower in women who received adjuvant vault radiation. Chemotherapy appears to confer longer survival for those women with Stage 1B or 1C disease compared of those observed or who had radiation alone. Conclusion. Adjuvant therapy appears to confer benefit in certain groups of women with stage 1 UPSC. A randomized controlled study would clarify the degree of benefit.

No cookie-cutter oncology: individualized treatment approaches for women with corpus endometrial cancer

Endometrial adenocarcinoma is the most common gynecologic malignancy and, for the majority of patients who present with stage I (approximately 70%) or stage II ( approximately 10%) disease, 5-year overall survival rates approach 85%. However, the complicated mix of medical comorbidities, the broad spectrum of techniques and treatment modalities and controversial clinical trial outcomes makes treating this heterogeneous group of patients unique and challenging. Similar management controversies exist and, when one factors in histologic variability, no flow-chart treatment algorithm can be easily constructed. This article will discuss data from key clinical trials, consider the role of routine lymphadenectomy as a component of surgical staging, discuss the heterogeneity of stage III patients in both presentation and response to treatment, review options for medically inoperable patients and reflect on current and upcoming protocols.

Endometrial cancer state of the science meeting

There is a pressing need to improve our understanding of endometrial cancer (EC) and uterine carcinosarcoma and to develop new treatment strategies to improve outcomes. In recognition of this, a State of the Science meeting on EC was held last November 28 and 29, 2006, in Manchester, United Kingdom. The meeting was cosponsored by the National Cancer Research Institute (UK), the National Cancer Institute (US), and the Gynecological Cancer Intergroup. The objectives of the meeting were as follows: 1. To review current knowledge and understanding of EC and its treatments. 2. To identify key issues for translational research and clinical trials. 3. To identify the most important trials for women with endometrial carcinoma and uterine carcinosarcoma, both those already underway or to be done, for which the Gynecological Cancer Intergroup might facilitate international cooperation.

Utility of kallikrein-related peptidases (KLKs) as cancer biomarkers

BACKGROUND

The human kallikrein-related peptidase (KLK) family consists of 15 highly conserved serine proteases, which are encoded by the largest uninterrupted cluster of protease genes in the human genome. To date, several members of the family have been reported as potential cancer biomarkers. Although primarily known for their biomarker value in prostate, ovarian, and breast cancers, more recent data suggest analogous roles of KLKs in several other cancers, including gastrointestinal, head and neck, lung, and brain malignancies. Among the proposed KLK cancer biomarkers, prostate-specific antigen (also known as KLK3) is the most widely recognized member in urologic oncology.

CONTENT

Despite substantial progress in the understanding of the biomarker utility of individual KLKs, the current challenge lies in devising biomarker panels to increase the accuracy of prognosis, prediction of therapy, and diagnosis. To date, multiparametric KLK panels have been proposed for prostate, ovarian, and lung cancers. In addition to their biomarker utility, emerging evidence has revealed a number of critical functional roles for KLKs in the pathogenesis of cancer and their potential use as therapeutic targets.

SUMMARY

KLKs have biomarker utility in many cancer types but individually lack sufficient specificity or sensitivity to be used in clinical practice; however, groups of KLKs and other candidate biomarkers may offer improved performance.

Clinical aspects of uterine papillary serous carcinoma

PURPOSE OF REVIEW

We review the demographic and clinicopathologic characteristics, and prognosis of women diagnosed with uterine papillary serous carcinoma, with a focus on clinical management.

RECENT FINDINGS

Pathologic evaluation of postmenopausal bleeding is preferred for patients who fit the profile of a high-risk endometrial cancer such as uterine papillary serous carcinoma. Women diagnosed with endometrial cancer who fit this profile and all women with uterine papillary serous carcinoma should undergo comprehensive surgical staging and aggressive cytoreduction of extrauterine disease. Adjuvant therapy remains controversial. Several recent investigations reported on the potential benefit of adjuvant chemotherapy, with many recommending additional loco-regional radiation.

SUMMARY

Despite the lack of randomized trials on uterine papillary serous carcinoma, several recent reports have provided insight into the diagnosis, surgical management, and adjuvant treatment of this high-risk endometrial cancer.