Endometrial serous carcinoma (uterine papillary serous carcinoma): precancerous lesions and the theoretical promise of a preventive approach

摘要

Uterine corpus cancers, the vast majority of which are endometrial carcinomas, are diagnosed in approximately 47,130 women every year in the United States, which makes them the most frequently diagnosed malignancy of the gynecologic tract, and the 4th most commonly diagnosed malignancy in women overall [1]. The vast majority of endometrial carcinomas are of the endometrioid histotype, are localized to the uterus at presentation, and accordingly have a good prognosis [2]. Endometrial serous carcinomas (ESC), also known as uterine papillary serous carcinomas, represent about 10% of endometrial carcinomas, and have traditionally been conceptualized as being a clinically aggressive histotype [3,4] since they are responsible for up to 40% of all deaths and recurrences associated with endometrial cancer [5]. At the clinical level, this aggressiveness is related, at least partially, to the comparatively higher stage at which ESC patients present [2]. For example, amongst the endometrial cancers reported to the International Federation of Gynecology and Obstetrics for the 1999-2001 period, only 1021 (13.9%) of the 7333 endometrioid cancers were late stage, as compared with 143 (41.3%) of 346 ESCs [2]. At least 37% of ESC cases that display no invasion in the uterus are found to have stage III or IV disease after comprehensive surgical staging, which highlights the significance of the latter procedure in accurately defining the extent of disease for patients with this cancer [6]. However, for patients that truly have uterine corpus-confined disease after surgical staging, and certainly those with stage IA, non-myoinvasive or minimally-invasive disease, the reported outcomes have been good to excellent [7-15], although the optimal adjuvant management for these patients remains a matter of debate [16,17]. For patients with stage III or IV disease, reported outcomes have generally been dismal, irrespective of adjuvant therapeutic modalities [18,19]. These findings highlight the importance of intercepting the disease at an early stage, and possibly applying an ablative intervention before its development [20,21].