Cancer of the corpus uteri: 2021 update

Abstract

Endometrial cancer is the most common gynecological malignancy in high‐ and middle‐income countries. Although the overall prognosis is relatively good, high‐grade endometrial cancers have a tendency to recur. Recurrence needs to be prevented since the prognosis for recurrent endometrial cancer is dismal. Treatment tailored to tumor biology is the optimal strategy to balance treatment efficacy against toxicity. Since The Cancer Genome Atlas defined four molecular subgroups of endometrial cancers, the molecular factors are increasingly used to define prognosis and treatment. Standard treatment consists of hysterectomy and bilateral salpingo‐oophorectomy. Lymphadenectomy (and increasingly sentinel node biopsy) enables identification of lymph node‐positive patients who need adjuvant treatment, including radiotherapy and chemotherapy. Adjuvant therapy is used for Stage I–II patients with high‐risk factors and Stage III patients; chemotherapy is especially used in non‐endometrioid cancers and those in the copy‐number high molecular group characterized by TP53 mutation. In advanced disease, a combination of surgery to no residual disease and chemotherapy with or without radiotherapy results in the best outcome. Surgery for recurrent disease is only advocated in patients with a good performance status with a relatively long disease‐free interval.

Role of Brachytherapy in the Postoperative Management of Endometrial Cancer: Decision-Making Analysis among Experienced European Radiation Oncologists

“…We only analyzed decision criteria mentioned by the experts. Among the participating peers, we found similar decision criteria used in the adjuvant management of EC, which were in accordance with the most recent guidelines [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ]. However, the criteria were implemented differently.…”

“…The primary management of operable EC is total hysterectomy and bilateral salpingo-oopherectomy [ 2 ]. The indication for adjuvant radiotherapy (RT) is based on the presence of adverse features for recurrence, such as higher disease stage, increased depth of myometrial invasion, higher histopathological grade, presence of lymphovascular space invasion (LVSI), lymph node involvement, and histologic subtype [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ]. There is also a development towards decision-making based on molecular features.…”

Association of Tumor Size With Prognosis in Patients With Resectable Endometrial Cancer: A SEER Database Analysis

“…Ts has not been adopted in the staging system in EC but has been used in other cancers, such as cervical cancer, liver cancer, and pancreatic cancer. ( 19 , 20 ) In cervical cancer, patients with the deepest invasion of ≥ 5 mm and lesion limited to the cervix uteri were grouped as stage IB. In the more detailed division, patients with a depth of stromal invasion ≥ 5 cm and Ts < 2 cm can be classified as IB1, patients with Ts of 2 to 4 cm can be grouped into IB2, and patients with Ts ≥ 4 cm can be categorized as IB3.…”

Molecular Regulation of Androgen Receptors in Major Female Reproductive System Cancers

“…EC is one of the most common malignancies in women, with low mortality due to its obvious early symptoms [ 96 ]. EC originates from the endometrium, which is a multicellular tissue.…”