Abstract
Background and objectiveThe incidence of synchronous primary endometrial and ovarian cancer is uncommon and poses a diagnostic challenge to the treating physician about their origin as either primary or metastasis. The purpose of this study was to evaluate the clinicopathological behavior, treatment modality-related outcomes, and prognosis related to primary endometrial and ovarian cancers at a tertiary care referral center in South Asia.MethodsWe retrospectively analyzed 30 patients with synchronous ovarian and endometrial cancers treated at Shaukat Khanum Memorial Cancer Hospital and Research Centre in Lahore, Pakistan from January 2005 to August 2017.ResultsThe median age of the patients at the time of diagnosis was 51 years (range: 25-72 years). The common presenting symptoms were irregular uterine bleeding (30%), post-menopausal bleeding (26.7%), abdominal mass (16.7%), and abdominal pain (26.7%). Endometrial adenocarcinoma type was the most common histological variant found among the participants: 90% (n=27) of uterine and 56.7% (n=17) of ovarian cancers. All patients underwent surgical intervention. Among them, 25 patients received platinum-based adjuvant chemotherapy, four received neoadjuvant chemotherapy, and 18 received adjuvant radiotherapy. The early-stage group [International Federation of Gynecology and Obstetrics (FIGO) stage I and II] had a more favorable prognosis than the advanced stage group (FIGO stages III and IV).ConclusionBased on our findings, patients with synchronous primary endometrial and ovarian cancers have better overall survival rates than patients with single primary ovarian or endometrial cancers. Also, synchronous primary endometrial and ovarian cancer endometroid types have better overall survival than patients with non-endometrioid or mixed histologic types.
Highlights
Synchronous malignancies in the female genital tract are very rare entities (0.5-1.7%)
Endometrial adenocarcinoma type was the most common histological variant found among the participants: 90% (n=27) of uterine and 56.7% (n=17) of ovarian cancers
World Health Organization (WHO) committee classification was used for histologic determination, and staging of both ovary and endometrium was devised on the basis of the International Federation of Gynecology and Obstetrics (FIGO) guidelines and the American Joint Committee on Cancer (AJCC) staging manual 8th edition
Summary
Synchronous malignancies in the female genital tract are very rare entities (0.5-1.7%). Synchronous endometrial and ovarian tumors are the most common types of malignancy, with a frequency of 5% among endometrial and 10% among ovarian primary tumors [1,2]. Clinical presentation of these women is indistinct, and extensive pathological evaluation has to be performed to distinguish synchronous endometrial and ovarian malignancies from the metastatic disease. Et al have described illustrative clinicopathological details and classified them into three groups: (a) primary endometrial tumors with ovarian metastasis, (b) primary ovarian tumors with endometrial dissemination, and (c) synchronous endometrial and ovarian malignancies [5]. The purpose of this study was to evaluate the clinicopathological behavior, treatment modality-related outcomes, and prognosis related to primary endometrial and ovarian cancers at a tertiary care referral center in South Asia
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