The surgical pathologic features of 621 patients with Stage I carcinoma of the endometrium are presented. All patients were treated with primary surgery consisting of total abdominal hysterectomy, bilateral salpingo-oophorectomy, selective pelvic and paraaortic lymphadenectomy and peritoneal cytology. An appreciable number of patients (144-2296) with Stage I cancers have disease outside of the uterus (lymph node metastasis, adenexal disease, intraperitoneal spread and/or malignant cells in peritoneal washings). Multiple prognostic factors particularly grade and depth of invasion are related to extrauterine disease. This study adds credence to the primary surgical approach with individualized postoperative therapy as indicated.

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INTRODUCTIONLast year, the American Cancer Society (ACS) announced that it was inaugurating a yearly report on its cancer detection guidelines. 1 The annual report would be a single summary source on current ACS guidelines for the early detection of cancer, including background and rationale for guidelines that had been updated in the prior year, announcements of upcoming guideline reviews, and a summary of the most recent data on adult cancer screening rates.During 2000, the ACS reviewed and revised early detecion guidelines for prostate cancer, colorectal cancer, and endometrial cancer, and updated the narrative related ABSTRACT Updates to the American Cancer Society (ACS) guidelines regarding screening for the early detection of prostate, colorectal, and endometrial cancers, based on the recommendations of recent ACS workshops, are presented. Additionally, the authors review the "cancer-related check-up," clinical encounters that provide case-finding and health counseling opportunities. Finally, the ACS is issuing an updated narrative related to testing for early lung cancer detection for clinicians and individuals at high risk of lung cancer in light of emerging data on new imaging technologies.Although it is likely that current screening protocols will be supplanted in the future by newer, more effective technologies, the establishment of an organized and systematic approach to early cancer detection would lead to greater utilization of existing technology and

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Methods. After all eligibility criteria were met, 453 cases were evaluable and analyzed for prognostic factors.Results. Of the 301 mixed mesodermal tumors (MMT), 167 were homologous (HO), and 134 were heterologous (HE). Fifty-nine tumors were leiomyosarcomas (LM). The remaining 93 sarcomas were predominantly stromal cell and adenosarcomas. For this study, only the MMT or LM tumors were analyzed. The recurrence rate for all MMT was 53% (HO, 44%; HE, 63%). The recurrence rate for LM was 71%. The site of the first recur-

Background On August 14, 2014, the United States Food and Drug Administration approved the anti-angiogenesis drug, bevacizumab, for women with advanced cervical cancer based on a 2012 interim analysis of 271 deaths on GOG protocol 240. We now report the planned protocol-specified final analysis of the primary objective, overall survival (OS). Methods A phase III randomized trial using a 2×2 factorial design was conducted to determine whether intravenous chemotherapy [(cisplatin 50 mg/m2 plus paclitaxel 135 or 175 mg/m2) or (topotecan 0.75 mg/m2 days 1–3 plus paclitaxel 175 mg/m2)] with or without bevacizumab (15 mg/kg) improves OS in recurrent/persistent/metastatic cervical cancer. Patients were prospectively stratified by performance status, prior radiosensitizing platinum, and disease status. We estimated enrolling 450 patients with 346 deaths at final analysis to provide 90% power to detect a 30% reduction in risk of death. Findings On March 7, 2014, 348 deaths occurred among 452 patients. Regimens administering bevacizumab continued to demonstrate significant improvement in OS: 16.8 vs 13.3 mos (HR 0.77;95% CI 0.62–0.95;p=0.0068). Updated progression-free survival also favored bevacizumab (HR 0.68;95% CI 0.56–0.84;p=0.0002). Final OS among 20% (n=91) not treated with prior pelvic radiotherapy was 24.5 (bevacizumab) vs 16.8 mos (without bevacizumab). Fistula (any grade) occurred in 14.5% (n=32) receiving bevacizumab (all previously irradiated). Grade 3+ fistula developed in 5.9% (n=13) and did not result in surgical emergency, sepsis and/or death. Post-progression OS was not significantly different among those who did and did not receive bevacizumab (median 8.4 vs 7.1 mos: HR 0.32;95% CI 0.66–1.05;p=0.06). Interpretation The benefit conferred by incorporation of bevacizumab is sustained with extended follow-up as evidenced by the survival curves remaining separated. Following progression on bevacizumab, a negative rebound effect was not observed. This represents proof-of-concept of the efficacy and tolerability of anti-angiogenesis therapy in advanced cervical cancer. Funding National Cancer Institute (USA).

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Carcinoma of the corpus uteri was staged clinically in the first instance, as had been done for cervical cancer. This appeared appropriate at the time because the true surgical-pathological spread pattern of endometrial cancer had not been evaluated in a systematic manner. Because endometrial cancer was more prevalent in an older population, there was a subcategory for those individuals who were medically inoperable. In 1971 a new classification was proposed, again using clinical staging but with the added prognostic factor of using the grade of the tumor as part of the staging. Since the vast majority of corpus uteri cancer was felt to be Stage I, this had the most attention. The size of the uterus as measured by the uterine depth was used to differentiate between Stage IA and IB (less than or greater than 8 cm in depth). With the addition of the histological differentiation of the cancer there were now 6 substages within Stage I.In the 1970s and early 1980s several studies were carried out in which systematic evaluation of surgical-pathological spread pattern was evaluated, with particular emphasis on the pelvis and para-aortic lymph nodes. Although data have been available since the 1950s concerning lymph node involvement, particularly as it related to Stage II cancers, for practical purposes this potential spread site was ignored in the management of this cancer. Studies that involved several hundred patients were carried out under the auspices of the Gynecologic Oncology Group (GOG) in the United States. As evaluation of these data was finalized it became apparent that in what was clinical Stage I endometrial cancer, an appreciable number (25%) of patients had disease outside of the corpus. Pelvic lymph nodes were involved with an increasing frequency as the grade of the tumor became more poorly differentiated and as the depth of myometrial invasion increased. Surgical staging therefore allowed more precise knowledge of the exact extent of the disease, which allowed more specific therapy.As a result of these landmark studies, in 1988 the FIGO Committee on Gynecologic Oncology -responsible for the publication of the Annual Report as well as for the evaluation and proposal of recommendations for gynecologic cancer staging -decided that corpus uteri cancer should be surgically staged. With specific information available, particularly regarding the depth invasion, these data were then applied as substaging within Stage I. Although the GOG studies had evaluated the depth of myometrial of invasion in fourths (endometrium, inner one-third, mid one-third, outer one-third), the FIGO Committee decided to divide the myometrium in half so that Stage IA was tumor limited to the endometrium, Stage IB to the inner one-half, and Stage IC to the outer one-half of the myometrium, but with the grade of the tumor also applied. There were now 9 substages within Stage I. The more advanced extent of disease was categorized appropriately, for instance lymph node metastasis was classified as Stage IIIC even if invasion in the myomet...