Localized Endometrial Cancer Research Articles

Oncoguía de cáncer de endometrio 2023

In Mexico, endometrial cancer ranks fifth in incidence and is the second cause of gynecological cancer after cervical cancer. The main risk factor for endometrial cancer is obesity and other conditions related to metabolic syndrome. The symptom that indicates the start of the approach is abnormal uterine bleeding, especially in postmenopausal patients. The standard of initial treatment for apparently localized endometrial cancer is hysterectomy. Lymph node evaluation provides relevant information on the prognosis and the need for adjuvant therapy. Various clinical and histological parameters have been associated with the survival of these patients. Additionally, data from the Cancer Genome Atlas project has increased our understanding of endometrial cancer's biological and prognostic heterogeneity. Several studies have evaluated the role of different adjuvant strategies, such as brachytherapy, radiotherapy, and chemotherapy. In advanced diseases, standard treatment consists of systemic therapy and other options include chemotherapy, hormone therapy, and immunotherapy. Surgery and radiation therapy can sometimes improve outcomes for patients with advanced disease. These guidelines aim to share with the oncology community the diagnostic and treatment strategies used at the National Cancer Institute to diagnose and treat endometrial cancer.

Recommandations pour la pratique clinique Nice/Saint-Paul-de-Vence 2022–2023 : prise en charge du cancer de l'endomètre localisé

Recommendations for clinical practice, Nice/Saint-Paul-de-Vence 2022-2023: Management of localized endometrial cancer Endometrial cancer is the most frequent gynecological cancers in industrialized countries and its incidence increases. The newmolecularclassification allows determination of the risk of recurrence and helps orienting therapeutic management. Surgery remains the cornerstone of treatment. Minimally invasive approach must be preferred for stages I and II. Surgery includes hysterectomy with bilateral adnexectomy, sentinel lymph node biopsy even in high risk diseases and omentectomy for non-endometrioid tumors (except in case of clear cells tumors). Fertility preservation can be proposed in low grade, stage I tumors without myometrial involvement. In stage III/IV disease, lymph node debulking without totallymphadenectomy is indicated. In case of peritoneal carcinomatosis, first-line cytoreductive surgery is recommended if complete resection can be achieved. Adjuvant therapy is not recommended in low risk tumors. In intermediate risk tumors, curietherapy is indicated. In tumors with high-intermediate risk, curietherapy and external radiotherapy are indicated according to prognostic factors (stage II, lymphovascular invasion); adjuvant chemotherapy can be considered on a case-by-case basis. In high risk tumors, chemotherapy and external radiotherapy are recommended using a concomitant or sequential approach.

Comparison of rates of vaginal brachytherapy vs. external beam radiation post-hysterectomy for endometrial cancer patients in rural vs. urban settings (459)

<b>Objectives:</b> The GOG-99 trial published in 2004 demonstrated that patients with high-intermediate risk endometrial cancer benefit from adjuvant external beam radiation therapy (EBRT) post-hysterectomy to decrease the risk of recurrence. The PORTEC-2 trial was then published in 2010, which was an open-label, non-inferiority randomized control trial that compared vaginal brachytherapy (VBT) to EBRT for patients with high-intermediate risk endometrial cancer. This trial demonstrated non-inferiority of VBT compared to EBRT with no significant difference in vaginal or locoregional recurrence, overall survival, and disease-free survival. However, it did show a significant decrease in grade 1-2 gastrointestinal toxicities in the VBT group. VBT is now the standard of care given its decreased toxicity but is also notably less time-consuming for patients. Our objective was to identify if there was a difference in the administration of VBT versus EBRT for endometrial cancer patients post-hysterectomy in rural versus urban locations. <b>Methods:</b> This is a retrospective cohort study based on the SEER 18 dataset of the US National Cancer Institute. Women with localized endometrial cancer post-hysterectomy were included in this study. The SEER dataset defines a localized tumor as a tumor confined to the organ of origin without extending beyond the primary organ. Data were collected from 2011 to 2018, given that PORTEC-2 was published in 2010. Urban versus rural population was defined by the rural-urban continuum codes. Women were excluded if they received both VBT and EBRT or if a rural-urban continuum code was not provided. Statistical analysis was completed with relative risk and confidence interval calculation. <b>Results:</b> In total, 10,840 women were included. There were 9813 women identified in metropolitan counties; 22% (<i>n</i>=2136) received EBRT post-hysterectomy for localized endometrial cancer, whereas 78% underwent VBT. There were 1027 women identified in nonmetropolitan counties, 22% (<i>n</i>=230) received EBRT and 78% (<i>n</i>=797) received VBT. When comparing metropolitan versus nonmetropolitan counties, there was no statistical difference between rates of EBRT versus VBT, with a relative risk of 1.16 (95% CI: 0.91-1.16, p=0.64). There were 125 women identified in completely rural counties, 21% (<i>n</i>=26) received EBRT and 79% (<i>n</i>=99) received VBT. There was no statistical difference in rates of radiation therapy between completely rural and metropolitan counties, with a relative risk of 0.95 (95% CI: 0.67-1.34, p=0.77). <b>Conclusions:</b> Living in a nonmetropolitan county or even a completely rural county was not associated with a difference in receiving EBRT versus VBT in patients with localized endometrial cancer status post-hysterectomy compared to rates in metropolitan counties. It could be inferred that even though rural counties may have fewer medical resources, patients are still receiving the standard of care in regard to radiation therapy for endometrial cancer.

Sentinel lymph node mapping for endometrial cancer: Opportunity for medical waste reform

ObjectiveAs healthcare expenditures continue to rise, identifying mechanisms to reduce unnecessary costs is critical. The objective of this study is to estimate the annual cost of wasted indocyanine green (ICG) used for sentinel lymph node mapping in patients with endometrial cancer. MethodsUsing the Surveillance, Epidemiology, and End Results program database and Premier database, we determined the annual number of cases in which sentinel lymph node mapping with ICG would be used and the median cost of ICG to institutions and patients, respectively. We assumed that gynecologic oncologists use 2-4 mL (20–40%) of the currently available ICG vial kit (25 mg per 10 mL) per case. Estimated waste was then calculated using cost as a measure of institutional waste and charge as excess cost transferred to patients or payers. ResultsAn estimated 45,864 cases of localized endometrial cancer were identified and eligible for sentinel lymph node (SLN) mapping. The mean total cost associated with ICG was 99.20 and the mean charge was $483.64. The estimated excess annual cost to hospitals was $2,729,825 to $3,639,767. Similarly, using mean charge data, the annual cost of wasted drug for patients and payers was $13,308,999 to $17,745,332. ConclusionsThe annual cost of wasted ICG due to its current manufactured vial size exceeds $2 million for hospitals and $13.3–$17.7 million for patients. We suggest ICG vials should be packaged in a 10 mg vial kit (2–4 mL sterile solution) to avoid drug waste and the financial impact to institutions and patients.

Intra-cavitary brachytherapy in endometrial carcinoma: experience with cobalt-60 source.

PurposeTo report vaginal cuff brachytherapy (VCB) dosimetry parameters and clinical outcomes of patients with localized endometrial cancer treated with adjuvant high-dose-rate (HDR) brachytherapy using a cobalt-60 (60Co) source.Material and methodsBetween 2011 and 2017, we identified patients with endometrial cancer treated with surgery and adjuvant VCB. Dosimetry variables analyzed included D2cc, D1cc, and D0.1cc for organs at risk (OARs) and distance from cylinder surface to 150% and 200% isodose line in vaginal mucosa. Local relapse (LR), regional relapse (RR), distant metastasis (DM), progression-free survival (PFS), and overall survival (OS) were analyzed using Kaplan-Meier, and log-rank test was applied to assess differences between groups. Toxicity evaluation was tested for possible cross-correlation within dosimetric parameters using Pearson r test and stepwise multivariate linear regression.ResultsWe identified 93 suitable patients. Mean age at diagnosis was 66 years (range, 45-85 years). Most patients had endometrioid adenocarcinoma (61.3%), followed by papillary-serous carcinoma (11.8%). 71% of patients presented with FIGO stage I (35.5% IA and 35.5% IB), 11.8% were stage II, and 17.2% were stage III. Adjuvant external beam radiotherapy (EBRT) (range, 46-50.4 Gy) was used in 53.8% of patients, and adjuvant chemotherapy in 38.7%. Median follow-up was 39 months (range, 5-84 months). Three-year OS and PFS were 87.5% and 85.5%, respectively. LR was seen in 2.2% of cases, RR in 7.5%, and DM in 12.9%. Mean rectum D2cc/D0.1cc were 88.1% and 116%, and mean bladder D2cc/D0.1cc were 79.2% and 103.2%, respectively. The most common acute toxicity was vaginal mucositis (8.9% ≥ G2), and the most frequent chronic toxicity was vaginal stenosis (25.3% ≥ G1).ConclusionsAdjuvant high-dose-rate VCB with 60Co source for patients with endometrial cancer is well tolerated, with clinical and toxicity outcomes comparable to those reported with iridium-192 (192Ir) source.

Annual cost of wasted indocyanine green during sentinel lymph node mapping for patients with endometrial cancer

<h3>Objectives:</h3> To estimate the annual cost of wasted indocyanine green (ICG) used for sentinel lymph node (SLN) mapping in patients with localized endometrial cancer. <h3>Methods:</h3> We used the Surveillance, Epidemiology, and End Results (SEER) program database to estimate the number of annual cases of localized uterine cancer. We queried the Premier database (www.premierinc.com; Premier, Inc; Charlotte, NC) to determine the median cost to institutions and charge to patients associated with ICG. We searched Premier for all patients who underwent surgery for endometrial hyperplasia or uterine cancer from January 2006 to June 2018. Among 142,629 patients, there were 12,543,758 billing records. The median charge and median variable cost associated with ICG were estimated from 7,826 records that identified ICG use in the hospital charge description. To further validate these estimates, we conducted a separate search for lymph node sampling and radiopharmaceutical mapping to confirm these billings were separate from ICG billings. To perform the drug waste analysis, we assumed that gynecologic oncologists use 2-4 mL of the only currently available ICG vial kit (25 mg per 10 mL) per SLN case, resulting in presumptive waste of 60-80% of the total vial. Estimated waste was then calculated using the variable cost as a measure of institutional waste and charge as excess cost transferred to patients or payers. <h3>Results:</h3> In SEER 2020, there were 65,520 estimated cases of uterine cancer. Seventy percent of these cases (45,934) were localized and thus eligible for SLN mapping. The median cost associated with ICG was $56.70 (25%ile: $22.32; 75%ile: $71.00), and the charge was $419.34 (25%ile: $219.79; 75%ile: $527.47). The estimated annual waste associated with current ICG packaging was $1,562,674 - $2,083,566 to hospitals. The estimated annual excess charge imposed on patients or payers was $11,557,178 - $15,409,570. <h3>Conclusions:</h3> The annual cost of wasted ICG due to its current manufactured vial size is $1.5-$2.1 million for hospitals and $11.5-$15.4 million for patients. This is a gross underestimate, as it does not include cases of atypical hyperplasia or vulvar cancer, which would also be eligible for SLN biopsy. We suggest ICG vials should be packaged and sold in a 10-mg vial size to avoid drug waste and excess costs to institutions and patients.

This Month in Adult Urology

This Month in Adult Urology

Contemporary Rates of Gynecologic Organ Involvement in Females with Muscle Invasive Bladder Cancer: A Retrospective Review of Women Undergoing Radical Cystectomy following Neoadjuvant Chemotherapy.

According to the American Urological Association/American Society of Clinical Oncology/American Society for Radiation Oncology/Society of Urologic Oncology Guideline on treatment of nonmetastatic muscle invasive bladder cancer (MIBC), females requiring radical cystectomy (RC) should undergo concomitant anterior pelvic exenteration despite low rates of malignant involvement of gynecologic organs. We present the clinicopathological characteristics of patients with MIBC treated with neoadjuvant chemotherapy (NAC) and evaluate the impact of NAC on gynecologic organ involvement. An institutional review board approved review of patients with cT2-T3 MIBC treated with RC at our institution between 2005 and 2018 was performed. Patients were stratified by receipt of NAC. A total of 186 females with cT2-T3 MIBC underwent RC during the study period, of whom 67.7% received NAC prior to RC. Patients who received NAC were more likely to have cT3 disease, preoperative hydronephrosis, and variant histology on transurethral resection (p <0.001, p=0.004, p=0.029, respectively). Rates of recurrence or metastasis were similar between groups (27.0% vs 26.7%, p=0.964). No patients had isolated genitourinary organ recurrence (median followup 32.1 months). Nine patients (5.7%) had gynecologic organ involvement (6 NAC vs 3 no NAC, p=0.978). Among those who underwent hysterectomy, 2 patients (3.1%) who received NAC had uterine involvement compared to none in the no NAC cohort (p=0.551). Rates of vaginal involvement were similar between the groups (4 NAC vs 3 no NAC, p=0.402). Additionally, 1 patient who received NAC had incidentally diagnosed localized endometrial cancer. No women had fallopian tube or ovarian involvement. Even among high risk patients with MIBC, gynecologic organ involvement of MIBC is rare, and organ preservation, especially of the ovaries, is likely safe.

Total Laparoscopic Hysterectomy with Pelvic/Aortic Lymph Node Dissection for Endometrial Cancer Using Passive Instrument Positioners: A Retrospective Case-Control Series

Study ObjectiveTo investigate the influence of the use of passive instrument positioners (PIPs) on laparoscopic operative outcomes for endometrial cancer relative to other independent variables. DesignRetrospective case-controlled study (Canadian Task Force classification II-2). SettingLaparoscopies performed by the author in multiple community hospitals. PatientsA total of 297 consecutive patients between December 2009 and October 2016 with clinically isolated endometrial cancer or retroperitoneal lymphadenopathy on imaging studies. InterventionsTotal laparoscopic hysterectomy with bilateral salpingo-oophorectomy and pelvic/aortic lymph node dissection using passive instrument positioners to secure the laparoscope (PIP group) and using instruments providing exposure and historical control by hand control of all instruments (HC group). Measurements and Main ResultsThe overall group mean age was 63.2 years (range, 32.4–90.9 years), and patient characteristics were equivalent in the 2 groups. In the PIP group, 1 procedure was converted to a laparotomy (0.5%), and in the HC group, 6 procedures were converted (5.4%; p = .008). The mean operative time was 140.1 minutes for the PIP group and 153.8 minutes for the HC group (p < .001). The mean length of hospital stay was 44.8 hours for the PIP group and 58.6 hours for the HC group (p < .001). Multivariate analysis confirmed that study group (PIP vs HC; p = .014) and the presence vs absence of metastatic disease (p = .001) influenced conversion; study group (PIP vs HC; p < .001), body mass index (p < .001), past surgical history (p = .010), and assistant training (p = .011) influenced operative time; and study group (PIP vs HC; p < .001), Eastern Cooperative Oncology Group performance status (p < .001), and operative time (p = .051) influenced hospital stay. ConclusionFor clinically localized endometrial cancer managed laparoscopically, the use of PIPs reduces conversions, operative time, and hospital stay.

Abstract B59: Racial disparities in surgical procedure and survival for endometrial cancer.

Abstract Objective: Hysterectomy is standard of care in the treatment of endometrial cancer. We will determine if endometrial cancer directed hysterectomy varies by race. Methods: The U.S. Surveillance, Epidemiology, and End Results (SEER) cancer registry was queried to identify 59,994 black and white women diagnosed with localized endometrial cancer from 2000-2009. Frequency of endometrial cancer directed hysterectomy was compared by race (white, black) and adjusted for age (&amp;lt;60 years, 60+) and tumor grade (low = grades I &amp; II, high = grades III &amp; IV). Reason for no hysterectomy was also queried. Five-year relative survival was also calculated using SEER*Stat 7.1.0. Results: Of the 59,994 women with localized endometrial malignancies in the study, 55,950 were white and 4,044 were black. White females with localized endometrial cancer were significantly more likely to undergo hysterectomy than their black counterparts (95.69% [94.88-96.5%] vs. 86.55% [86.55-92.4%]). Black women 60 and older were significantly less likely to receive hysterectomy than their white counterparts (87.50% vs. 94.96%). In accounting for grade, white women with low grade endometrial cancer were significantly more likely to undergo hysterectomy than black women (96.23% vs. 91.37%). There was no significant difference in hysterectomy in women less than age 60 or among those with high-grade disease. When reason for no hysterectomy was queried, it was found that reason “not recommended” was significantly higher for black women than white women (50.82% [44.28-58.05%] vs. 40.28% [37.79-42.90%]). Furthermore, when accounting for age and grade, black women were still more likely to have no surgery because it was not recommended, but the only statistically significant racial disparity was in women less than 60 years old (41.57% [38.26-44.97%] vs. 54.41% [46.02-62.56%]). Five-year survival for all women with hysterectomy was 98.8% (95% CI = 98.4-99.1%). White subjects that underwent hysterectomy had a significantly higher 5-year survival than black subjects (99.2% [98.7-99.5%] vs. 92.6% [90.6-94.1%]). The significant racial difference in 5-year survival persisted when accounting for age and grade. Conclusions: We found substantial racial disparities between black and white women with localized endometrial cancer in the frequency of hysterectomy performed and in 5-year survival. This, as yet, unexplained racial disparity merits further study to identify causative factors to ultimately improve health care outcomes for all women with endometrial cancer. Citation Format: Travis-Riley K. Korenaga, Kristy K. Ward, Michael T. McHale, Cheryl C. Saenz, Steven C. Plaxe. Racial disparities in surgical procedure and survival for endometrial cancer. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B59.

Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Total laparoscopic hysterectomy with pelvic/aortic lymph node dissection for endometrial cancer—a consecutive series without case selection and comparison to laparotomy

Objective To determine feasibility of duplicating operative time and nodal yield of “open” procedures by using laparoscopy for clinically localized endometrial cancer without case selection and eliminating influence of BMI on conversion. Methods In this retrospective study 210 consecutive patients were laparoscoped between July, 2006 and November, 2009 to perform total laparoscopic hysterectomy with bilateral salpingoophorectomy and pelvic/aortic lymph node dissection (TLH/BSO/LND) using pulsed bipolar cautery to complete all phases of the procedure. Outcomes (“Scope” group) are compared to historic consecutive TAH/BSO/LND controls (“Open” group) operated on 2004–2009 and “open” series in the literature. Results Two hundred (95.2%) procedures were completed laparoscopically, 3 (1.4%) required a minilaparotomy to remove the uterus, and 7 (3.3%) were converted to complete the hysterectomy with some portion of LND. There was no influence of BMI ( P = 0.688), age ( P = 0.748) or the number of prior abdominal operations ( P = 0.875) on probability of conversion (Logistic regression). The mean age, BMI, number of prior abdominal procedures, and GOG performance status were equivalent in both study groups. The mean operative time was 139.5 min (IQR 125–152) for the “Scope” group and 128.4 min (IQR 105–124) for the “Open” group ( P = 0.008). The mean nodal yield was 34.7 (IQR 24–40) for the “Scope” group and 25.7 (IQR 18–30) for the “Open” group ( P < 0.001). The mean hospital stay was 3.2 days (IQR 2–4) for the “Scope” group and 7.9 days (IQR 5–9) for the “Open” group ( P < 0.001). Conclusions For clinically localized endometrial cancer, TLH/BSO/LND can functionally duplicate operative time equivalent to “open” procedures, while improving nodal yield, and minimizing influence of BMI on conversion to laparotomy and case selection.

Adjuvant vaginal brachytherapy alone for high risk localized endometrial cancer as defined by the three major randomized trials of adjuvant pelvic radiation

Adjuvant vaginal brachytherapy alone for high risk localized endometrial cancer as defined by the three major randomized trials of adjuvant pelvic radiation

Adjuvant vaginal brachytherapy alone for high risk localized endometrial cancer as defined by the three major randomized trials of adjuvant pelvic radiation

Objective. Controversy exists regarding optimal management of high risk localized endometrial cancer. Given that vaginal brachytherapy (VB) alone is used routinely at our institution, we retrospectively reviewed our outcomes among high risk patients defined according to the PORTEC, GOG 99, and/or Aalders randomized trials of pelvic radiation versus observation to determine if acceptable rates of locoregional control could be achieved with vaginal brachytherapy alone in this highest risk patient population. Methods. The Roswell Park Cancer Institute hospital tumor registry was used to identify all patients with Stage I or IIA endometrial cancer treated between January 1992 and June 2006. A total of 464 patients were identified. Of 261 patients who received post-operative RT, 225 received VB alone. Of those 225, 87 met the high risk criteria as designated by PORTEC (at least 2 of the following high risk features: age > 60, Grade 3, and/or myometrial invasion ≥ Occurrences of the mathematical operator ‘(=’ were changed to ‘Œ’. Please check.-->50%), GOG 99 (any age with 3 high risk features: Grade 2–3, > 66% myometrial invasion, and/or LVSI; age ≥ 50 with 2 high risk features; or age ≥ 70 with 1 high risk feature), and/or Aalders (Stage IC, Grade 3). Descriptive recurrence statistics are provided. Results. Among 87 high risk patients treated with VB alone, 36, 77, and 14 were high risk per PORTEC, GOG 99, and Aalders respectively. Forty (46%) underwent pelvic lymph node dissection. With a median follow-up of 52 months, 3 (3.4%) pelvic recurrences were observed including 1 vaginal recurrence, 1 pelvic recurrence, and 1 local recurrence involving both the vagina and pelvis. All 3 local recurrences were successfully salvaged with pelvic RT ± surgery. Conclusions. This represents one of the largest known series of high risk localized endometrial cancer treated with VB alone. The observed 3.4% locoregional recurrence compares favorably with the 5% locoregional recurrence noted among the highest risk patients receiving pelvic RT in the PORTEC, GOG 99, and Aalders randomized trials. In this single institution experience, the 3 local recurrences were salvaged. Based on these findings, we will continue to use VB alone in the adjuvant setting for patients with high risk localized endometrial cancer.

Racial disparities in recurrence among patients with early‐stage endometrial cancer

AbstractBACKGROUND.Population‐based studies suggest that, because of inequalities in treatment, black women with localized endometrial cancer have shorter survival compared with white women. The objective of the current investigation was to determine whether there is a racial disparity in outcome between black patients and white patients with early‐stage endometrial cancer treated similarly in a clinical trial setting.METHODS.A retrospective review of 110 black patients and 1049 white patients with stage I and II endometrial cancer (graded according to the International Federation of Gynecology and Obstetrics grading system) was performed using data from a randomized, placebo‐controlled trial performed by the Gynecologic Oncology Group that evaluated postoperative estrogen replacement therapy (ERT) and the risk of cancer recurrence. Demographic, pathologic, treatment, and outcome‐related data were collected and analyzed using regression and survival analysis.RESULTS.Estimates of recurrence‐free survival suggested that black patients may be more likely to have disease recurrence, particularly those receiving ERT. Within a median follow‐up of 3 years, 5 of 56 black patients with endometrial cancer in the ERT group were identified with recurrent disease compared with only 8 of 521 white patients. Adjusted for age, body mass index, and tumor grade, the relative risk of recurrence among blacks in the ERT group was 11.2 (95% confidence interval, 2.86‐43.59; P = .0005).CONCLUSIONS.The findings of the current study suggested that recurrence‐free survival may be shorter among black women with stage I endometrial cancer, even in a clinical trials setting in which patients receive similar treatment and follow‐up. This increased risk of recurrence appeared to be most evident in black women with endometrial cancer who maintained ERT after primary treatment. Cancer 2008. Published 2008 by the American Cancer Society.

Adjuvant vaginal brachytherapy alone for high-risk localized endometrial cancer as defined by PORTEC, GOG 99, and Aalders

Adjuvant vaginal brachytherapy alone for high-risk localized endometrial cancer as defined by PORTEC, GOG 99, and Aalders

Predictive value of preoperative serum CA 125 levels in clinically localized and advanced endometrial carcinoma

Serum CA 125 levels were measured preoperatively by standard radioimmunometric techniques in 89 patients with primary endometrial carcinoma before definitive surgical staging and resection. Fifty-seven of 58 (98%) patients with clinical and surgical Stage I or II disease had normal preoperative serum CA 125 levels. All eight patients with clinically advanced endometrial cancer (International Federation of Gynecology and Obstetrics Stage III or IV) had elevated CA 125 levels before surgery. Twenty of 23 patients (87%) with clinical Stage I or II endometrial cancer who were found to have extrauterine spread of disease during staging laparotomy had elevated preoperative serum CA 125 levels. Thus preoperative CA 125 levels were elevated in 28 of 31 patients (90.3%) with surgically staged endometrial adenocarcinoma with extrauterine disease and may play a useful role in detecting those patients with clinically localized endometrial cancer who have occult extrauterine spread of disease.