Endometrial Cancer

The Society of Gynecologic Oncology (SGO) recently issued two new clinical practice statements recommending genetic testing for all women with endometrial and ovarian cancers, regardless of family history.

As advances in treatment strategies continue to focus on individualization of therapy, the identification of disease subsets is crucial to strategizing optimal therapeutic approaches.

In this review, the results and limitations of studies concerning adjuvant radiation therapy and chemotherapy for endometrial cancer will be discussed, focusing on evidence that can help to guide treatment decisions.

Future directions, including nomograms, multi-modality approaches, and more individualized patient care based on genomic profiles, may help to tailor each endometrial cancer patient’s therapy to her individual risk.

Using easy-to-obtain risk factors for breast, ovarian, and endometrial cancers, researchers have come up with models that can predict an individual woman’s absolute risk for developing each type of cancer.

The data on HE4 as a prognosticator in both ovarian and endometrial cancer constitute, at most, an interesting observation, but most likely they are simply a reflection of total tumor burden. There are certainly not enough data to justify making major treatment decisions in ovarian or endometrial cancer on the basis of absolute marker levels. Proteomics and genomics seem more likely to make a difference in this area.

While a prominent role for HE4 in these areas remains to be determined, this thorough review of HE4 demonstrates that the biomarker is complementary to, and occasionally more useful than, the widely used CA 125 in the management of gynecologic malignancies.

In this review, we discuss the discovery and biologic significance of HE4 and evaluate available evidence regarding the utility of HE4 as a biomarker for ovarian and endometrial cancer.

Women diagnosed with endometrial cancer at age 50 or younger had a fourfold increased risk for a subsequent colorectal cancer diagnosis, according to a historical cohort study published recently in the Journal of Clinical Oncology.

Coffee is emerging as a protective agent against a number of diseases, including cancer. A study published last week shows that women who drank more than four cups of coffee per day cut their risk of endometrial cancer by 25% compared with those who drank less than one cup per day.

Patient education and counseling are essential in women at increased risk for ovarian and endometrial cancer. Women must be educated regarding the signs, symptoms, and risks associated with these cancers.

Don Dizon, MD, Brown University, discusses the paradigm shift in the treatment of endometrial cancer with the use of medical therapy, including chemotherapy with biologics, mTOR inhibitors combined with chemotherapy, and targeted therapies.

The European Society of Gynaecological Oncology (ESGO) biennial meeting is taking place in Milan, Italy, and will run from September 11-14, 2011.

Physicians must engage and educate patients about significant risk for cardiovascular disease.

A modified radical hysterectomy (class II) did not improve locoregional control and survival compared with simple extrafascial abdominal hysterectomy (class I). Investigators from University of Milano-Bicocca in Monza, Italy, randomized 520 patients with stage I endometrial cancer to class I or class II surgery. They found that the median length of parametria and vagina removed were 15 mm and 5 mm respectively for class I hysterectomy vs 20 mm and 15 mm for class II hysterectomy (P > .001). Operating time and blood loss were statistically significantly higher for class II hysterectomy. Five-year disease-free survival and overall survival was 87.7% and 88.9% respectively in the class I arm, and 89.7% and 92.2% in the class II arm (Ann Surg Oncol online, October 16, 2009).

Comparative uptake of two radiotracers allows characterization of tumor.

Endometrial cancer is the most common gynecologic malignancy, with an estimated 40,100 cases and 7,470 deaths in 2008. This malignancy represents 6% of all cancers, and 3% of cancer deaths in women. Endometrial cancer is more prevalent in older women, with an incidence of 1 in 142 for women 40 to 59 years old, increasing to 1 in 81 women over 70 years old.[1] Median age at diagnosis is 62.[2] The mortality of endometrial cancer has decreased from 4.18 to 4.12 per 100,000 from 1991 to 2004.

Published analyses combining groups of patients with different risk profiles have created confusion surrounding patient selection for adjuvant treatment after surgery for endometrial cancer. As a result, no randomized trial has demonstrated a survival benefit with the addition of adjuvant radiation

In this issue of ONCOLOGY, Diavolitsis et al have provided an excellent overview of the literature and state of our understanding of the role of adjuvant therapy in the treatment of endometrial cancer.

Patients with endometrial cancer who have minimally invasive robotic-assisted hysterectomies tend to have quicker surgeries and shorter hospital stays compared with patients who have similar laparoscopic surgical procedures, according to new research from The Ohio State University Comprehensive Cancer–James Cancer Hospital and Solove Research Institute.

The first phase III study of its kind has found that vaginal brachytherapy—in which a radioactive cylinder is inserted into the vagina—is as effective at preventing the recurrence of higher-risk endometrial cancer as external-beam radiation therapy, has fewer side effects, and results in a better quality of life for patients (abstract LBA5503).

For women with a gynecologic cancer, reproductive concerns may vary not only by site of disease but also by the presentation and manifestation of the disease. Gynecologic cancer can present before childbearing has been started or completed, during pregnancy, or can even arise out of pregnancy.

Carcinoma of the endometrium is the most common female pelvic malignancy and the fourth most common cancer in females, after breast, bowel, and lung carcinomas. In 1995, an estimated 32,800 new cases of endometrial carcinoma and 5,900 related deaths will occur in the United States [1]. The relatively low mortality for this cancer is probably due to the fact that in 80% of cases, the disease is diagnosed when it is confined to the uterus.

Results from Oncolytics Biotech's phase I trial of Reolysin, its oncolytic reovirus, show stable disease in 7 of 32 patients with advanced or metastatic solid tumors refractory to standard therapy or for which no curative standard therapy exists. Dr. Timothy Yap of The Institute of Cancer Research, Sutton, UK, presented the study at the 18th EORTC-NCI-AACR Symposium on Molecular Targets and Cancer Therapeutics

Hospitalized oncology patients are at particular risk for acute venous thromboembolism (VTE); however, more often than not, a standard for VTE prophylaxis does not exist, according to Jerelyn Osoria, RN, OCN, of Memorial Sloan-Kettering Cancer Center. Ms. Osoria reported at the Oncology Nursing Society 31st Annual Congress (abstract 113) that an electronic medical orders system and better nursing documentation have helped improve this situation at her institution's Gynecology (GYN) oncology inpatient nursing unit.