w Serous Endometrial Carcinoma represents approximately 10% of endometrial carcinomas
w The tumors often deeply invade the myometrium
w It has the tendency for peritoneal spread , unlike typical endometrial adenocarcinom
Lee et al. Recurrence in nonivasive endometrial carcinoma. Am J Surg Pathol 2001;15:965-973.
Introduction
w Advanced Disease presentation is common
w Recurrence of the disease is very high
w Even in cases of minimally invasive or confined to the endometrium in polyps
w Spread rate to adenexia is 50%
Silva et al. Serous carcinoma in endometrial polyps. Mod Pathol 1990;3:120-128.
Chambers et al. Uterine Papillary Serous Carcinoma. Obst Gynecol 1987;69:109-113.
Introduction w 60% of cases will be upstaged after complete surgical staging
(Microscopic identification)
w Closely resembles serous carcinoma of Ovary and Fallopian tube
w Lymphatic invasion is commonplace in myometrium
w Psammoma bodies frequently observed
Wilson et al. Evaluation of unfavorable histologic subtypes in endometrial adenocarcinoma. Am J Obstet Gynecol 1990;162:418.
Jeffrey et al. Papillary serous adenocarcinoma of the endometrium. Obstet Gynecol 1986;67:670.
The Proportional Hazards of relative survival time (Clinical Stage I and II) Zaino et al. Pathologic models to predict outcome for women with endometrial adnocarcinoma. Cancer 1996;77 :1119.
w Serous Carcinoma
w Endometriod Ca
w Grade 1 RR 2.9
w Grade 1 RR 1
w Grade 2 RR 4.4
w Grade 2 RR 1.6
w Grade 3 RR 6.6
w Grade 3 RR 2.6
Diagnosis
w Typically Diagnosed on endometrial biopsy prompted by postmenopausal bleeding
w It is not hormone sensitive, so it dose not develop from endomerial hperplasia
w It arises in setting of endomerial atrophy
Grundker et al. Hormonal heterogeneity of endometrial cancer. Adv Exp Med Biol. 2008;630:166-88.
Diagnosis w The median age at diagnosis of 138 women in the Goldberg et al study was 67 years.
w 54 (40%) women diagnosed at stage I
w 20 (14%) women at stage II
w 41 (30%) women at stage III
w 23 (16%) women at stage IV
Goldberg et al. Gynecol Oncol. 2008 Feb;108(2):298-305
Management
w Regular Metastatic workup
w Surgical staging (+Cytology) with Total abdominal Hysterectomy, Bilateral Salpengoophrectomy, Omentectomy and Lymphadenectomy
w Adjuvant Chemotherapy and Radiotherapy
Management
w Goldberg et at. 138 women with UPSC followed up 1986 - 2003
w Median follow up for the surviving patients was 44 months
w 129 patients had surgery and 122 patients rendered free of gross disease and comprised the adjuvant group
Goldberg et al. Outcome after Combined modality treatment for uterine papillary serous carcinoma. Gynecol Oncol. 2008 Feb;108(2):298-305
Management
w 23 patients received platinum-based chemotherapy
w 52 patients had radiotherapy
w 28 Patients had combined chemoradiotherapy
Goldberg et al. Outcome after Combined modality treatment for uterine papillary serous carcinoma. Gynecol Oncol. 2008 Feb;108(2):298-305
Management
w At last follow up:
w 57 patients were alive free of disease
w 10 patients alive with disease
w 62 patients died of disease
w 8 patients died of another causes
w One patient died due to toxicity
Goldberg et al. Outcome after Combined modality treatment for uterine papillary serous carcinoma. Gynecol Oncol. 2008 Feb;108(2):298-305
Management
w Five year disease free survival (DFS) was 42%
w Disease specific survival (DSS) was 56%
w Overall Survival for the 122 patients treated with curative intent was 54%
Goldberg et al. Outcome after Combined modality treatment for uterine papillary serous carcinoma. Gynecol Oncol. 2008 Feb;108(2):298-305
Management
w Surgical treatment as the sole therapy for patient with UPSC is unacceptable
w Chemotherapy, radiotherapy or both have been added after surgery to improve survival
w Survival benefit to patients from such multimodality therapy remains uncertain
Sood et al. Pattern of failure after the multimodality treatment of uterine papillary serous carcinoma. Int J Radiat Oncol Biol Phys. 2003 Sep 1;57(1):208-16
Management
w Pattern of failure after multimodality treatment studied by Sood et al
w 42 patients reviewed retrospectively between 1988 and 1998
w Median follow up for all patients was 19 months
Sood et al. Pattern of failure after the multimodality treatment of uterine papillary serous carcinoma. Int J Radiat Oncol Biol Phys. 2003 Sep 1;57(1):208-16
Management
w 29 (69%) patients had recurrence at the time of last follow up
w Failure rate at 2 years was 58% and at 5 years was 67%
w 19 of 29 patients had recurrence in abdomen, vagina or pelvis (66%)
Sood et al. Pattern of failure after the multimodality treatment of uterine papillary serous carcinoma. Int J Radiat Oncol Biol Phys. 2003 Sep 1;57(1):208-16
Management
w Metastases outside the abdomen 17% only
w 25 patients (60%) died at time of reporting
w 2 years survival rate is 52% and 5 years survival rate is 43%
Sood et al. Pattern of failure after the multimodality treatment of uterine papillary serous carcinoma. Int J Radiat Oncol Biol Phys. 2003 Sep 1;57 (1):208-16
Management
w No increased survival in stage I UPSC who had surgery and adjuvant radiation therapy versus observation
w Postsurgical chemotherapy in stageI may be beneficial but more data needed
Huh et al. Uterine papillary serous carcinoma: comparisons of outcomes in surgical stage I patients with and with out radiotherapy. Gynecol Oncol. 2003 Dec;91(3): 461-2.
Management
w 60% of UPSC cases were found to overexpress the protein HER2/neu
w Same protein overexpressed in some cases of breast cancer
w Monoclonal antibody Trastuzumab (Herceptin) has been tried with some success in phase II trial in UPSC with HER2/neu
Santin et al. Trastuzumab treatment in patients with advanced or recurrent endometrial carcinoma overexpressing HER2/neu. Int J Gynaecol Obstet 2008. 102(2):128-31
