Cancer Site, Regional Nodes, Most Common Sites of Metastasis
The two types of uterine cancer are endometrial cancer (the most common type) and uterine carcinoma (quite rare). The former starts in the uterus lining, while uterine carcinoma starts in uterus muscles and supporting tissues (National Comprehensive Cancer Network® [NCCN], 2021). Endometrial cancer grows in the uterus and may expand to the cervix glands, further metastasis can spread in the entire reproductive system and other systems of the female body. It can affect the urinary bladder and rectum lining, fallopian tubes, pelvic lymph nodes as well as upper abdomen, and even lungs, bones, liver, paraaortic lymph nodes, and other lymph nodes (Amin et al., 2017). Uterine carcinoma, starting in the uterus, grows into abdomen tissues, rectum, and bladder, while it may or may not reach nearby lymph nodes.
Most Common Histology
The most common histologic type of uterine cancer is endometrioid carcinoma (or epithelial malignancies). Such tumors mainly have a favorable prognosis, and they are manifested at an early stage of development. Affected females have abnormal uterine bleeding, which is one of the most common symptoms of the disorder (Amin et al., 2017). In some cases, such histologic types as clear cell or serous endometrial carcinoma occur, and they tend to have a negative prognosis. The development of endometroid carcinomas is characterized by the uninterrupted endometrial proliferation that is simulated by hormones and results in endometrial hyperplasia.
Diagnostic Confirmation Tests
Several diagnostic confirmation tests can be used to determine the type of cancer and its stage. The biopsy is one of the common tests that involve the removal of a sample of tissue from the endometrium (NCCN, 2021). This method is effective in detecting endometrial cancer but is a less reliable strategy for diagnosing uterine sarcoma. If later stages of cancer are diagnosed, a biopsy of the cervix to determine whether the disease spread to that tissue is conducted. Imaging is another widely employed diagnostic tool used to confirm the diagnosis (or estimate the degree of the damaged areas). X-ray testing or CT scanning are common diagnostic strategies, but they are characterized by a significant negative impact on the body as the patient is exposed to a considerable amount of radiation. MRI and ultrasound are common strategies that are commonly utilized and seen as safer as no radiation is released.
Prognosis tests are implemented to identify the type and stage of cancer development and trace the disorder’s progression. Biomarker testing is a central prognosis test that enables healthcare professionals to develop and change (if necessary) treatment plans (NCCN, 2021). MMR/MSI testing is performed on biopsy material and concentrates on genetic aspects. This test is ordered for endometrial cancer but can also be effective with uterine sarcomas. MMR/MSI testing is instrumental in determining the effectiveness and relevance of immunotherapy. Tumor mutational burden refers to the total quantity of mutations in cancer cells’ DNA. This biomarker helps in identifying whether immune checkpoint inhibitor therapy can be effective.
NTRK gene fusion urges uncontrolled cell growth. NTRK testing is advisable to diagnose endometrial cancer that spreads to distant areas, uterine sarcomas, and recurrent cancer. Hormone receptor testing helps in identifying whether, in cancer cells, there are proteins to which hormones can attach. Estimating the exact types of hormones that attach to these proteins (also referred to as receptors) is important for developing proper treatment. HER2 tests determine whether there is HER2 protein on the surface of cancer cells, which helps in developing appropriate treatment plans.
First Course Treatment Available
Surgery is the first-course treatment for uterine cancer these days. Total hysterectomy and bilateral salpingo-oophorectomy imply the removal of the cervix and uterus, as well as fallopian tubes and ovaries (NCCN, 2021). Other types of surgery can also be utilized depending on the progression of the disorder and some other factors. Radiation therapy is another common type of cancer treatment, and it encompasses the use of high-energy waves to destroy cancer cells. Systemic therapy involves the utilization of different types of substances. Chemotherapy, immunotherapy, and targeted therapy stop the growth of cancer by killing cancer cells or inhibiting their proliferation. That this kind of medication also kills healthy cells, which is manifested in hair loss, skin issues, and mouth sores (NCCN, 2021). Endocrine therapy aims at killing cancer cells by activating (or adding) some hormones. These drugs include but are not confined to medroxyprogesterone, levonorgestrel, megestrol acetate, and anastrozole, letrozole, and exemestane, among others.
Median Age at Diagnosis
The median age at diagnosis is 63, and the most affected group of women are women aged between 55 and 64 years old (33.5% of all cancer cases) (Surveillance, Epidemiology, and End Results Program [SEER], 2021). Older women aged 65-74 are also at a high risk of uterine cancer development (29.4%). Among patients diagnosed with this type of cancer, over 15% are females older than 75. Approximately 15% of all cases are women aged 45-54, and almost 5% are those aged between 35 and 44 years old.
The primary risk factors associated with the development of uterine cancer include age, family history, excessive weight, diabetes, Lynch syndrome, never giving birth, the use of tamoxifen, excessive amount of estrogen, as well as late or early periods. Thus, females aged 55 or older are at a high risk of uterine cancer development. Being overweight and childless also increases the risk of developing this type of cancer. Therefore, hereditary and lifestyle peculiarities can be seen as the central risk factors associated with uterine cancer.
Although this type of cancer is not the most common, uterine cancer affects a considerable number of women. For example, in 2018, it was estimated that 813,861 females had uterine cancer in the USA (SEER, 2021). In 2021, 66,570 new cases were identified, so the prevalence of this type of cancer is still high. Compared to other types of cancer, uterine cancer accounts for 3.5% of cases in the United States.
There is no significant difference in the incidence of uterine cancer across races: 28.6% of all new cases are diagnosed in white women, with a similar rate (28.1) in Black females (SEER, 2021). Out of all new cases, 25.3% were in Hispanic women, and 22.3 were Asian and Pacific Islanders. The major difference in this rate is related to females’ age, which has been discussed above.
Compared to all cancer deaths, the mortality rate among females diagnosed with uterine cancer accounts for 2.1.% (SEER, 2021). It has been estimated that 12,940 women will die of uterine cancer in 2021. There is a certain disproportion in death rates among people of different races. Black patients constitute the largest group in death rate per 100,000 people by race: 8.8. This rate is 4.6 for white women, 4.2 for Hispanic females, 3.8 and 3.4 for American Indian/ Alaska Native and Asian/ Pacific Islander, respectively. The median age at death is 70 years old as the groups of patients aged 65-74 are more likely to die. Notably, although the rate of new cases per 100,000 people had declined (reaching 27.9) since the mid-1970s when it was 35.5, the death rate per 100,000 individuals remains almost unchanged (from 5.3 in 1975 to 5.0 in 2019). In the 2000s, the death rate fluctuated with a drop to 4.0.
The 5-year relative survival rate among patients with uterine cancer was 81.1% from 2011-2017. In terms of race, the survival rate is similar for all races, excluding black females. The relative survival among white, Hispanic, Asian/Pacific Islanders and Native Americans is similar and is near 80%, while only about 60% of black women survive (SEER, 2021). The stage of cancer rate at diagnosis has a substantial influence on patient survival. If diagnosed at stage 1, the 5-year relative survival rate is almost 95%. It is noteworthy that over 67% of patients with uterine cancer are diagnosed at early stages (localization or stage 1). Approximately 20% of females are diagnosed at the regional stage (cancer reached regional nodes), and 9% are diagnosed at the distant stage when metastasis reaches other areas. The following 5-year relative survival rate is identified among these groups: 69.3% for the regional stage and 17.8% for the distant stage. Thus, screening and regular check-ups are critical for early diagnosing and the development of the most effective treatment plans.
Amin, M. B., Edge, S. B., Greene, F. L., Byrd, D. R., Brookland, R. K., Washington, M. K., Gershenwald, J. E., Compton, C. C., Hess, K. R., Sullivan, D. C., Jessup, J. M., Brierley, J. D., Gaspar, L. E., Schilsky, R. L., Balch, C. M., Winchester, D. P., Asare, E. A., M. Madera, Gress, D. M., & Meyer, L. R. (2017). AJCC cancer staging manual (8th ed.). Springer.
National Comprehensive Cancer Network®. (2021). Uterine cancer: Endometrial carcinoma: Uterine sarcoma. Web.
Surveillance, Epidemiology, and End Results Program. (2021). Cancer stat facts: Uterine cancer. Web.