Carcinoma of the Endometrium Surveillance Counterpoint: Japan

Abstract

Endometrial carcinoma is the third most common female genital tract carcinoma in Japan and its incidence is increasing. According to the Center for Cancer Control and Information Services at the National Cancer Center, endometrial cancer accounted for 6,625 new cancer cases in Japan in 2002 [1]. The incidence of endometrial cancer recurrence is also increasing proportionately. In 2006, the number of endometrial cancer-related deaths was 1,481, over three times higher than that reported 20 years ago (Fig. 61.1). Recently, the incidence of endometrial cancer among younger patients, under 39 years of age, has also increased in Japan (from 75 patients in 1975 to 355 patients in 2002 [1]). In younger patients, hormone therapy has been attempted at several institutions in order to preserve fertility. Endometrial cancer generally has a favorable prognosis because about 80 % of cases are diagnosed in stage I. For endometrial cancer, routine surgicopathological staging, including lymph node examination, has been recommended by the Cancer Committee of the International Federation of Gynecology and Obstetrics (FIGO) since 1988. With early-stage endometrial cancer, only approximately 10–15 % of patients will experience recurrence. The primary aim of the follow-up strategy for endometrial cancer patients is thus to facilitate the early detection of recurrent lesions. It is generally assumed that detecting recurrence before symptoms have developed will permit earlier treatment and hence improve prognosis and survival rate. The goals of follow-up are to improve overall survival duration and to improve quality of life. However, a standard program for the follow-up of endometrial cancer patients has not yet been established. Generally, the risk of endometrial cancer recurrence depends on surgicopathological factors, including histological type and grade, depth of myometrial invasion, presence of lymph node metastasis, and the presence of extrauterine disease. Differences in operative technique and adjuvant therapy between Japan and the West may influence the type of recurrence.