ReviewManagement of women with uterine papillary serous cancer: A Society of Gynecologic Oncology (SGO) review☆☆
Introduction
- 1.
What distinguishes uterine papillary serous carcinoma (UPSC) from endometrioid (EEC) and other endometrial histologic subtypes?
- 2.
Based on available evidence, what is the best approach to the management of women with UPSC?
Endometrial cancer remains the most common gynecologic malignancy in women in the United States. In 2008, an estimated 40,100 new cases of endometrial cancer will be diagnosed and 7470 deaths will occur. The incidence of endometrial cancer is approxi- mately the same as the incidence of all other female genital tract malignances combined [1]. While the incidence and mortality rates from several other cancers have plateaued or decreased in the last decade, rates for endometrial cancer continue to rise [1]. Although the reasons for this are likely multifactorial, findings from a recent SEER database study of more than 45,000 women with endometrial cancer suggest that the increase in mortality may be related to an increased rate of advanced-stage cancers and high-risk histologies including UPSC [2].
Although UPSC represents approximately 10% of all endometrial cancer diagnoses, it accounts for up to 39% of endometrial cancer related deaths [[2], [3], [4]]. This disproportion makes clear the need for improved management. Unfortunately, prospective randomized study of UPSC has been hampered by its relative rarity. Evidence-based management is thus difficult to develop and expert consensus has been slow to evolve.
On this note, the Society for Gynecologic Oncologists (SGO) working through the Clinical Practice Committee (CPC) initiated development of a series of reviews addressing the less common gynecologic malignancies for its members and affiliates. The current report pertains to UPSC.
Section snippets
Methods
In 2007, at the 38th Annual Meeting on Women's Cancer, sponsored by the SGO, a subcommittee of the CPC was formed to begin development of clinical reviews for subject areas where consensus was perceived as lacking. The subcommittee determined an initial set of topics and prepared drafts of guidelines for review by the CPC. Final drafts were discussed with the SGO Council and other appropriate SGO committees before publication.
Epidemiology
Lauchlan and Hendrickson et al. first established UPSC as a distinct subtype of endometrial cancer describing it as histologically similar to serous epithelial ovarian carcinoma [5,6]. Shortly thereafter Bokhman proposed the existence of two categories of endometrial carcinoma characterized by distinct microscopic appearance, epidemiology, and clinical behavior (Table 1) [7]. Type I carcinomas display endometrioid histology and typically arise in relatively younger women with obesity,
Questions
- 1.
What distinguishes uterine papillary serous carcinoma (UPSC) from endometrioid (EEC) and other endometrial histologic subtypes?
- 2.
Based on available evidence, what is the best approach to the management of women with UPSC?
Target population
This review is focused on women with primary or recurrent UPSC.
Key evidence
- •
Although UPSC comprises <10% of all endometrial carcinoma cases, it accounts for a disproportionately high number of endometrial cancer related deaths and affects African American women more frequently than
Conflict of interest statement
The authors of this review have no conflict of interests to declare.
Acknowledgments
Members of the Clinical Practice Committee, Mary Eiken (SGO administration) and Jennifer Bethke (SGO administration).
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The Society of Gynecologic Oncologists Clinical Practice Committee is providing this evidence-based medicine summary of current clinical science to SGO members to help facilitate treatment planning.