Fast Facts: Endometrial Cancer

S.M. de Boer, R. Iyer, S.J. Kitson

Description

Endometrial cancer (EC) is the most common cancer of the uterus and the only gynecologic malignancy that is increasing in incidence and mortality. Early-stage EC generally has a good prognosis but 5-year survival is poor for those with advanced-stage disease or recurrent disease. This resource provides the latest information on epidemiology, risk factors and diagnosis, including the implications of Lynch syndrome in younger women, and the latest thinking on classification, grading, staging and prognostic risk groups, made possible by major advances in the molecular characterization of EC. The therapeutic implications of these advances are still being discovered and here we outline the latest evidence-based therapies and management of the disease. Table of Contents: • Epidemiology and risk factors • Diagnosis • Grading, staging and prognosis • Molecular characterization • Treatment of early-stage disease • Management of advanced and recurrent disease • Research directions

Sujets

• Medical
• Médecine
• Oncology

Informations

• Publié par: S. Karger AG
• Date de parution: 03 novembre 2022
• Nombre de lectures: 0
• EAN13: 9783318072426
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

Fast Facts: Endometrial Cancer
First published 2023
Text 2023 Sarah J Kitson, Rema Iyer, Stephanie M de Boer
2023 in this edition S. Karger Publishers Ltd
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ISBN 978-3-318-07085-9
Kitson SJ (Sarah)
Fast Facts: Endometrial Cancer/
Sarah J Kitson, Rema Iyer, Stephanie M de Boer
Medical illustrations by Graeme Chambers, Belfast, UK.
Typesetting by Amnet, Chennai, India.
Printed in the UK with Xpedient Print.
The development of this Fast Facts book on Endometrial Cancer has been fully funded by Eisai Europe Ltd. Eisai has had no editorial input nor influence over the scientific content within the book.
Contents
Foreword
List of abbreviations
Introduction
Epidemiology and risk factors
Diagnosis
Grading, staging and prognosis
Molecular characterization
Treatment of early-stage disease
Management of advanced and recurrent disease
Research directions
Useful resources
Index
Foreword
Endometrial cancer is the most common gynecologic malignancy, and it is increasing in incidence. Recently, we have learned a lot more about the molecular characteristics of endometrial cancer, which has led to a better understanding of the disease. We have also learned to use these molecular factors as prognostic and predictive markers in the adjuvant and recurrent settings.
Endometrial cancer is most often treated with surgery, and over the past decade surgical techniques have evolved substantially, with the use of minimally invasive surgery and the sentinel node procedure now commonplace. In addition, adjuvant radiotherapy and/or chemotherapy have been the subject of many randomized trials, resulting in better and adapted use of these modalities. Finally, the use of targeted therapies, such as immune checkpoint inhibitors, exportin-1 inhibitors and vascular endothelial growth factor (VEGF) inhibitors, has changed the treatment landscape substantially in the recurrent setting.
This concise practical resource provides healthcare professionals with excellent evidence-based advice, in line with current guidelines, enabling them to treat and support women with endometrial cancer.
Professor Emeritus Ignace Vergote
University Hospitals Leuven
Belgium
List of abbreviations
AJCC: American Joint Committee on Cancer
ASA: acetylsalicylic acid (aspirin)
BMI: body mass index
CI: confidence interval
CN: copy number
CRT: chemoradiotherapy
CT: computed tomography
EBRT: external beam radiotherapy
EC: endometrial cancer
EMA: European Medicines Agency
ER: estrogen receptor
ESGO: European Society of Gynaecological Oncology
ESP: European Society of Pathology
ESTRO: European Society for Radiotherapy and Oncology
ET: endometrial thickness
FDA: Food and Drug Administration
FFPE: formalin-fixed, paraffin-embedded
FFS: failure-free survival
FIGO: International Federation of Gynecology and Obstetrics
HER2: human epidermal growth factor receptor 2
HR: hazard ratio
HRD: homologous recombination deficiency
HRT: hormone replacement therapy
ICG: indocyanine green
IHC: immunohistochemistry
IUS: intrauterine system
L1CAM: L1 cell adhesion molecule
LVSI: lymphovascular space invasion
MMR: (DNA) mismatch repair
MMRd: mismatch repair deficiency
MRI: magnetic resonance imaging
MSI: microsatellite instability
MSI-H: high microsatellite instability
MSS: microsatellite stable
NSMP: no specific molecular profile
OCP: oral contraceptive pill
OS: overall survival
p53abn: abnormal expression of p53
PARP: polyadenosine diphosphate (ADP)-ribose polymerase (inhibitor)
PCOS: polycystic ovary syndrome
PD-1: programmed cell death protein 1
PD-L1: programmed death ligand 1
PET-CT: positron emission tomography and computed tomography
PFS : progression-free survival
PIFU: patient-initiated follow-up
PMB: postmenopausal bleeding
POLE mut: mutation of the exonuclease domain of the POLE gene
PORTEC: Postoperative Radiation Therapy in EC (group)
PR: progesterone receptor
PRoMisE: Proactive Molecular Risk Classification for EC (group)
PS: performance status
RFS: recurrence-free survival
RT: radiotherapy
SDI: sociodemographic index
SERM: selective estrogen receptor modulator
SLN: sentinel lymph node
TAP: paclitaxel-doxorubicin-cisplatin
TC: carboplatin-paclitaxel
TCGA: The Cancer Genome Atlas (group)
TKI: tyrosine kinase inhibitor
TMB: tumor mutational burden
TNM: tumor-node-metastasis
TVUS: transvaginal ultrasound
VBT: vaginal brachytherapy
Introduction
Endometrial cancer (EC) is the most common cancer of the uterus and the only gynecologic malignancy that is increasing in incidence and mortality. Early-stage EC generally has a good prognosis but 5-year survival is poor for those with advanced-stage disease or recurrent disease.
This resource provides the latest information on epidemiology, risk factors and diagnosis, including the implications of Lynch syndrome in younger women, and the latest thinking on classification, grading, staging and prognostic risk groups, made possible by major advances in the molecular characterization of EC. The therapeutic implications of these advances are still being discovered and here we outline the latest evidence-based therapies and management of the disease.
Most women with EC undergo surgery that has an immense physical and mental impact on their wellbeing. It is vital that all those who look after them, both physically and mentally, have the most up-to-date information at their fingertips. We therefore hope that the multidisciplinary team of healthcare professionals involved in the diagnosis, treatment, care and aftercare of women with EC will find this resource of value.
1 Epidemiology and risk factors
Endometrial cancer (EC) arises from the endometrium or lining of the uterus and is the most common type of uterine malignancy. Worldwide, it is the sixth most frequent female malignancy; in 2020, there were over 417 000 new cases diagnosed, and numbers are increasing. 1 Traditionally, EC was divided into two types: endometrioid tumors (formerly type 1), accounting for more than 80% of cases non-endometrioid tumors (formerly type 2): serous carcinomas, clear cell carcinomas, undifferentiated tumors and carcinosarcomas.
Endometrioid EC frequently presents at an early stage and has an excellent 5-year survival. Once the disease has spread outside the uterus, however, the prognosis is much poorer. Treatment can also be made more difficult by the presence of multiple comorbidities.
It should be noted that the histological classification above has, to a large extent, been replaced by a more accurate molecular-based system, which was initially proposed by The Cancer Genome Atlas (TCGA) and has since been refined for the clinic by other groups. Four molecular types of EC have been defined, which have a profound impact on diagnosis, treatment and prognosis (see Chapter 4 ).
Incidence
The incidence of EC is highest in North America and Europe, which reflects the effect of a Westernized diet and lifestyle (with higher rates of obesity) on EC risk. In Europe, it is the fourth most diagnosed malignant neoplasm in women (after breast, colorectal and lung cancer). An estimated 130 000 new cases were diagnosed in 2020, contributing to 6.8% of all new cancer cases. 2 In the USA, an estimated 65 620 new cases of EC were diagnosed in 2020, contributing to 3.6% of all new cancer cases. 3
Over the last 30 years there has been a substantial, and almost universal, global increase in the number of EC diagnoses. The UK, for example, has recorded a 55% rise in cases since the early 1990s. 4 While the greatest increase has been observed in countries with a high sociodemographic index (SDI), increases have also been observed in middle and low-middle SDI countries ( Figure 1.1 ). 5 This has been predominately attributed to the rising worldwide prevalence of obesity, with which, of the 20 most common cancer types, EC has the strongest association. Other likely contributing factors include an aging population, growing rates of diabetes, a reduction in the number of hysterectomies performed for abnormal uterine bleeding and smaller family size. The only areas with a decreasing trend in EC incidence are Central and Eastern Sub-Saharan Africa. It is interesting to note that the incidence of EC decreased in high SDI countries during the 1980s because of reduced use of unopposed estrogens in postmenopausal women.

Figure 1.1 Trends in the global disease burden of EC prevalence by SDI from 1990 to 2017. From Zhang et al. 2019, reproduced under CC BY 4.0 license. 5
Mortality
In line with the increase in disease incidence, global mortality related to EC has also increased