Endometrial Serous Carcinoma: Its Molecular Characteristics and Histology-Specific Treatment Strategies

Kentaro Nakayama,Masako Ishikawa,Kohji Miyazaki,Naomi Nakayama

doi:10.3390/cancers4030799

Abstract

Endometrial cancer is the fourth most common malignancy in women, with most cases being classified as early stage endometrioid tumors that carry a favorable prognosis. The endometrial serous histological subtype (ESC), however, while only accounting for 10% of all endometrial cancers is responsible for a disproportionate number of deaths. Unlike the estrogen-dependent, well differentiated endometrioid tumors, which are commonly associated with a younger age of onset, ESCs are estrogen-independent and tend to present at an advanced stage and in older women. Treatment for ESC entails aggressive surgery and multimodal adjuvant therapy. In this review, we describe the clinical behavior, molecular aspects, and treatment strategies for ESC.

Highlights

Endometrial cancer is classified into two subtypes: Type I and Type II (ESC, clear cell histology) [1]
We have evaluated the efficacy of chemotherapy combined with adjuvant radiotherapy [36,37]
Histology-specific treatment algorithms are needed to improve outcomes; the development of standardized protocols through randomized controlled trials has been hampered by the rarity of the subtype

Summary

Introduction

Endometrial cancer is classified into two subtypes: Type I (endometrioid histology) and Type II (ESC, clear cell histology) [1]. Type II cancers including ESC and clear cell carcinomas, are not associated with increased exposure to estrogen, and carry a poor prognosis. Endometrial cancer treatment has been dictated by grade and stage; it is clear that histology-specific treatment algorithms are required if the prognosis of ESC is to be improved. ESC has a high propensity for early lymphovascular invasion, as well as intraperitoneal and extra-abdominal spread. It commonly presents at an advanced stage. Unlike Type I tumors, in which spread to the regional lymph nodes may be predicted by the depth of myometrial invasion and tumor grade, there are no clear predictive factors of extra-uterine disease for ESC. Investigation into the treatment of endometrial carcinoma should include and document tumors with any percentage comprised of ESC [9]

Pathological and Molecular Features of ESC

Surgical Treatment

Chemotherapy

Combination of Chemotherapy and Radiation Therapy

Findings

Conclusions