Endometrium

—Straughn JM, Numnum TM, Kilgore LC, Partridge EE, Phillips JL, Markman M, Thomas GM, Burke TW.  The Use of Adjuvant Radiation Therapy in Patients with Intermediate-Risk Stage IC and II Uterine Corpus Cancer: A Patient Care Evaluation Study from the American College of Surgeons National Cancer Data Base.  Gynecol Oncol 99, no.3 (December 2005): 530-5.

—Hicks ML, Phillips JL, Parham G, Andrews N, Jones WB, Shingleton HM, Menck HR. The National Cancer Data Base report on endometrial carcinoma in African-American women. Cancer 1998; 83(12): 2629-2637. (!)

Although the incidence of uterine cancer is lower among African-American women compared with white women, their mortality rates are higher. The cases from the National Cancer Data Base (NCDB) represented 52,307 non-Hispanic white women and 3,226 African-American women diagnosed with primary carcinoma of the endometrium between 1988 and 1994. More African-American patients were diagnosed with less favorable histologic types than white patients, and they were diagnosed at more advanced stages of disease and with less tumor differentiation. Income had no effect on stage or grade. African-American patients were treated less often for their disease at every stage of diagnosis compared with white women. Income also generally had no effect on whether treatment was received, but limited income was associated with a lack of treatment of African-American patients diagnosed with American Joint Commission on Cancer (AJCC) stage IV endometrial carcinoma. African-American women were less frequently treated surgically and, among surgically-treated patients with advanced disease, they received adjuvant radiotherapy less often and chemotherapy more often than white patients. Five-year relative survival was poorer for African-American women, even for patients with the more favorable stage I adenocarcinoma diagnosis who were surgically treated. The authors conclude that all patients, regardless of race, should be treated appropriately as indicated by medical and prognostic factors and not by race. Although no screening methods currently exist for endometrial carcinoma, the development of procedures for identifying patients at risk for the prognostic factors that lead to a poor outcome should be a primary focus.

—Partridge EE, Shingleton HM, Menck HR. The National Cancer Data Base report on endometrial cancer. J Surg Onc 1996; 61:111-123. (!)

Data were received for 36,341 endometrial cancer patients. No significant change in stage distribution for patients who were staged was noted with time. Markedly fewer patients were reported with unknown stage in 1992 (15.6%) compared with 1986-1987 (45.1%). Blacks and low income groups were more likely to present with advanced stage disease. A 12.6% increase in patients undergoing nodal dissection as part of their surgical treatment occurred during this time period. More patients received surgery only as part of their treatment in 1992 (53.8% vs. 42.6%). Advancing age, minority status, low income, and increasing grade all had a negative impact on survival. Blacks experienced a 25% reduction in survival compared to non-Hispanic whites and Hispanics. Lack of improvement in detecting early disease indicates the lack of an acceptable screening methodology for this disease. African-Americans present with more advanced disease and subsequently have a decreased survival compared to non-Hispanic whites. Time trends indicate that nodal dissection is becoming a more common surgical practice in this disease, and that radiation therapy is utilized less often. The current American Joint Committee on Cancer staging accurately reflects differences in prognosis by stage.

—Partridge EE, Shingleton HM, Menck HR. Endometrial cancer. In: Steele GD, Jessup JM, Winchester DP, Menck HR, Murphy GP: eds. National Cancer Data Base: Annual review of patient care, 1995. Atlanta, GA: American Cancer Society, 1995; 48-65.

Data were received on 19,245 endometrial cancer cases from 1986-1987, and 17,096 cases from 1992. These data represent approximately 27% and 53% of all endometrial cancers diagnosed in the United States in 1986-1987 and 1992, respectively. African-American women represent a relatively small percentage of patients with endometrial cancer, but the ratio of early- to late-stage disease for this group is considerably lower than for other ethnic groups. (1.5:1 for African Americans vs 3.2:1 for non-Hispanic whites). Smaller differences were reported among income groups, but low-income patients had fewer stage 0 and I cancers. A majority of patients in the low-income group are non-Hispanic whites, indicating that income rather than race may explain many of the ethnically related differences in stage. Surgical trends of significance include a 12.6% increase in the proportion of women undergoing nodal dissections and/or biopsies (from 20.1% in 1986-1987 to 32.7% in 1992). Only 5.0% of women in the 1981 PCE study on endometrial cancer received nodal dissections. The frequency of this procedure has thus increased 27.7% between 1981 and 1992. Patients undergoing endometrial cancer surgery are more likely to have nodal dissections if the procedure is reported from an NCI-designated cancer center or a teaching hospital. Trends indicated that a larger percentage of patients are undergoing treatment with surgery only, probably because of the lack of convincing evidence that radiation therapy is beneficial to patients who are shown surgically/pathologically to have disease confined to the fundus, i.e., stage I. The likelihood that a patient will receive radiation therapy also appears to increase with age. As expected, and as seen with other cancers, advancing age, low income, and increasing grade of tumor all have a negative influence on survival. African-Americans are more likely than other ethnic groups to receive multimodality therapy, reflecting their advanced stage at presentation. The 25% lower 5-year survival rate among African- Americans compared with that among non-Hispanic whites and Hispanics is particularly troublesome and needs further study.

—Wharton JT, Mikuta JJ, Mettlin CJ, Murphy GP, Snyder CJ, Piver MS, Natarajan N, Donegan WL. Risk factors and current management in endometrial carcinoma: A survey by the American College of Surgeons. Surg Gynecol Obstet 1986; 162:515-520. (*)

The American College of Surgeons Commission on Cancer conducted a survey to define patterns of care for carcinoma of the endometrium in the United States. From March 1, 1981 to February 28, 1982, 564 hospitals reported on 7,220 women with carcinoma of the endometrium. Of these patients, 6,907 had invasive disease and 313 had in situ carcinoma. Ninety-two percent of the patients were 50 years or older at the time of diagnosis. According to the FIGO staging system, 81% had disease confined to the uterus. Adenocarcinoma was the most common histologic type and the majority were either well or moderately differentiated. More than 90% of the patients were treated with hysterectomy. Radiation therapy was used either preoperatively or postoperatively in 3,046 patients. Four hundred ninety-eight patients were treated with radiation only, and 182 did not undergo operation or irradiation. Five hundred twenty-five (7.7%) had second primary tumors with carcinoma of the breast, colon, or ovaries being the most common. More than 85% of the patients who underwent operation were discharged from the hospital in less than 14 days. There were nine postoperative deaths (0.02%).

—Donegan WL, Wharton JT. Carcinoma of the endometrium: A survey of practice. Bulletin of the American College of Surgeons 1984; 69:5-8. (*)

A total of 7,220 patients treated for endometrial cancer between 1981 and 1982 participated in the study. 313 patients had in situ carcinomas and 6,907 had invasive cancer. Most of the patients were white and more than a third were over 70. Eight percent were premenopausal. Thirty-nine percent had taken estrogen, progesterone, or oral contraceptives. Prominent risk factors were determined to be obesity, diabetes mellitus, and hypertension. Cancer of the breast was the most frequent second malignancy.

 

Revised May 23, 2007

 

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