Uterine Cancer Patients Research Articles

WE‐AB‐207B‐04: A Preliminary Investigation of Indicators for Treatment Outcomes of CT Guided Cervical Cancer Brachytherapy

Purpose:To identify indicators for recurrence in cervical cancer patients treated with high‐dose‐rate brachytherapy (HDR‐BT).Methods:A total of 37 biopsy proven uterine cervical cancer patients of stage IB‐IVA treated between 2011 and 2015 were included in this study. All patients were treated with 37.8–52.2Gy of external beam radiotherapy (EBRT) plus 5 × 5.0–6.5Gy of HDR‐BT. Patient age, standard deviation of high‐risk clinical tumor volume (HR‐CTVSD) collected throughout HDR‐BT, and D90 (EQD2, α/β=10Gy) of the HR‐CTV were investigated as potential indicators for local/distant recurrence using ROC analysis. The optimal cutoff value was identified through the Youden index and was subsequently used to obtain a group assignment for all patients. Another two comparing groups were defined per evidence of post‐EBRT tumor shrinkage based on the pre‐HDR MR scan. Kaplan‐Meier curves were generated for recurrence‐free proportions for comparing groups where time was measured from the final HDR treatment date to the date of the final follow‐up exam and compared through Cox regression.Results:Patients had a median follow‐up of 12 months, where 16% had local pelvic recurrence and 16% had distant recurrence. HR‐CTVSD was identified as a statistically significant indicator for recurrence (AUC=0.802, p=0.007) compared to D90 (AUC=0.655, p=0.167) and patient age (AUC=0.683, p=0.103). HR‐CTVSD of 6.26cc was chosen as the optimal cutoff value, which was used as the basis for patient group assignment. Patients with HR‐CTVSD>6.26cc had a hazard ratio of 3.92 (95% CI‐1.37, 11.24; p=0.011) for recurrence compared to HRCTVSD≤ 6.26cc. Patients without evidence of post‐EBRT tumor shrinkage compared to those with had a hazard ratio of 4.28 (95% CI‐1.14, 16.15; p=0.032) for recurrence.Conclusion:HR‐CTVSD was identified as an indicator for recurrence and an optimal value of 6.26cc was established in our study. In addition, patients without evidence of post‐EBRT tumor shrinkage demonstrated an increased recurrence rate.

A population‐based registry study evaluating surgery in newly diagnosed uterine cancer

The aim was to evaluate surgical treatment of newly diagnosed uterine cancer in a Swedish population. Data in the GynOp registry from 2008 to 2014 were analyzed. In total, 3443 cases were included: 430 (12%) were robotic-assisted laparoscopic, 272 (8%) laparoscopic, and 2741 (80%) abdominal operations. There was an increasing trend in minimally invasive surgery from 2008 to 2014 (41%). Women with lymph nodes removed in the robotic-assisted laparoscopic group experienced less blood loss (mean 105 vs. 377 mL), shorter length of hospital stay (2.4 vs. 4.1 days), and fewer days to normal activities of daily living (6.5 vs. 12.7 days) (all p < 0.001) compared with the abdominal group, but operating time did not differ. Similar results were found in women with no lymph node removal and in women with body mass index ≥35. Major complications during hospital stay, reoperations, and time to work were less in both minimally invasive groups. More lymph nodes were retrieved in the abdominal (mean 34.4) than in the robotic-assisted laparoscopic (mean 26.0) group, but the number of women with lymph node metastases did not differ, totaling 211/960 (21.9%; 95% CI 19.4-24.7%). Isolated para-aortic lymph node metastases were found in 3.9% (95% CI 2.4-5.6%) of women. Minimally invasive surgery in uterine cancer patients reduces days to normal activities of daily living, number of days to return to work, length of hospital stay, and blood loss in patients without and with lymph node dissection and in obese patients.

Race-based disparities in loss of functional independence after hysterectomy for uterine cancer.

Racial disparities in uterine cancer-related outcomes have been reported. The goal of this study was to determine if race, pre-operative body mass index (BMI), and medical comorbidities are predictors of loss of functional independence after hysterectomy for uterine cancer. Loss of independence was defined as a change from pre-operative functional independence, to a post-operative requirement of discharge to a post-care facility, or death within the first 30days following uterine cancer surgery. Demographic factors, comorbidities, BMI, intra-operative and post-operative outcomes, and discharge status were abstracted from the 2011 and 2012 American College of Surgeons National Surgical Quality Improvement Program (NSQIP). Statistical analyses included multivariable logistic regression and Wald tests for interaction. A total of 4005 patients had uterine cancer and were functionally independent pre-operatively. After adjusting for clinical features and comorbidities, Black women were not significantly more likely to lose functional independence than non-Black women. However, a significant interaction (OR=1.17, p<0.001) was found between race and BMI for loss of functional independence. Interaction plots revealed worsening functional outcomes for Black women with BMI >40 but not in non-Blacks. The interaction suggests a 17% increased odds of losing independence for each unit of BMI difference for Black uterine cancer patients, or 170% increased odds of losing independence for a 10-point increase in BMI, given a linear association. To reduce the likelihood of losing post-operative functional independence, Black, high-BMI patients with or at risk for uterine cancer may especially benefit from weight loss or interventions to optimize physical function.

Progestin-releasing intrauterine device insertion plus palliative radiotherapy in frail, elderly uterine cancer patients unfit for radical treatment.

The present study investigated the combination of levonorgestrel-releasing intrauterine device (LNG-IUD) insertion and palliative radiotherapy (RT) as a potential approach for treating frail, elderly endometrial cancer (EC) patients considered unfit for curative oncological treatments. The inclusion criteria were an age of ≥65 years, pathological confirmation of a uterine neoplasm, a Charlson comorbidity index (CCI) value of ≥4 and the presence of vaginal bleeding. Patients underwent intrauterine insertion of an LNG-IUD, and thereafter, received a total dose of 30 Gy at 3 Gy per fraction, over 10 days. The clinical target volume (CTV) was defined as the uterus and disease-involved tissues in the pelvis plus a 1-cm margin. The planning target volume was obtained by adding a 1-cm isotropic margin to the CTV. A total of 9 patients with EC (median age, 85 years; Eastern Cooperative Oncology Group performance status ≥2, ≥88.8%; obesity, 55.5%; median CCI, 5) received an LNG-IUD plus RT. An early complete resolution of bleeding was documented in 8 patients (88.8%), while the remaining patient experienced a marked improvement. The median duration of bleeding control was 18 months, while the 2-year actuarial rate of bleeding-free survival was 53.3% (median follow-up time, 20 months; range, 9-60 months). No LNG-IUD- or severe RT-related complications were documented. Overall, a high rate of bleeding remission, durable bleeding-free survival in face of the easy intrauterine insertion of an LNG-IUD and a negligible toxicity profile of the complete treatment were documented in this study, indicating a requirement for further investigation in a larger series.

Intraoperative navigation in robotically assisted compartmental surgery of uterine cancer by visualisation of embryologically derived lymphatic networks with indocyanine-green (ICG).

Background and ObjectivesTo evaluate feasibility of intraoperative visualization of embryologically defined organ compartments and their drainage by ICG in uterine cancer.MethodsTotal of 2.5 mg of ICG have been injected into cervix or corpus in uterine cancer patients immediately prior to surgery. Green fluorescence was intermittently detected during robotically assisted laparoscopic surgery (Firefly System®, Intuitve Surgical Inc.). Total of 36 patients with uterine cancer without macroscopically suspicious nodes were evaluated with respect to their compartmental lymphatic network, collecting lymphatic vessels, and the connection to the postponed lymph basins.ResultsMüllerian (sub) compartment and transport of lymph fluid along the lymphatic collectors and connecting vessels to the postponed lymph basins could be visualized invariably in all patients. Cervix drained along the ligamentous and caudal part of vascular mesometria, whereas midcorporal and fundal drainage occurred along the upper part of vascular mesometria and along the mesonephric pathway along the ovarian vessels.ConclusionsVisualization of lymphatic network and downstream flow of lymphatic fluid to the postponed lymph basins by ICG is feasible; it can be used to navigate along compartment boarders for education, intraoperative orientation, and quality control. It seems to confirm the compartmental order of pelvic organ systems and postponed lymph basins. J. Surg. Oncol. 2016;113:554–559. © 2016 Wiley Periodicals, Inc.

Risk of secondary urinary bladder cancer (UBC) in patients receiving radiotherapy for rectal cancer, prostate cancer, and gynecologic malignancies.

363 Background: Radiotherapy proximal to the bladder mucosa may incite malignant transformation. We investigated this phenomenon using a large population-based national database. Methods: The SEER13 database from 1992 to 2012 was reviewed for bladder cancer patients who had a history of any previous cancer, including solid tumors and hematologic malignancies. Data regarding the use of radiotherapy was reviewed. Information was analyzed using standardized incidence ratios (SIRs), defined as the ratio of observed to expected cases adjusted by person years at risk. SIRs are considered statistically significant if corresponding 99% exact confidence intervals (CIs) exclude 1.0. All results were standardized using a referent population matched to the index cases based on age, sex, race, and time period. Results: A total of 20,341 patients with secondary UBC were identified. A higher incidence in secondary UBC was seen amongst rectal, prostate cervical and uterine cancer patients receiving radiotherapy (see Table). Patients with lung cancer had a higher incidence of secondary UBC irrespective of radiotherapy use. Compared to patients with secondary UBC and no prior radiotherapy, patients with secondary UBC with prior radiotherapy had a higher rate of localized disease (79% vs 75%, P &lt; 0.0001) and had poorer survival on multivariate analysis (HR 1.06, 95%CI 1.05-1.06; P &lt; 0.0001). Conclusions: Patients with selected abdominal and pelvic tumors who received radiotherapy had a higher rate of secondary UBC. Further study is needed to determine whether these cancers represent a biologically distinct entity. [Table: see text]

The role of interstitial brachytherapy in the management of primary radiation therapy for uterine cervical cancer.

PurposeThe aim of this study was to report the clinical results of uterine cervical cancer patients treated by primary radiation therapy including brachytherapy, and investigate the role of interstitial brachytherapy (ISBT).Material and methodsAll consecutive uterine cervical cancer patients who were treated by primary radiation therapy were reviewed, and those who were treated by ISBT were further investigated for clinical outcomes and related toxicities.ResultsFrom December 2008 to October 2014, 209 consecutive uterine cervical cancer patients were treated with primary radiation therapy. Among them, 142 and 42 patients were treated by intracavitary and hybrid brachytherapy, respectively. Twenty-five patients (12%) were treated by high-dose-rate (HDR)-ISBT. Five patients with distant metastasis other than para-aortic lymph node were excluded, and 20 patients consisted of the analysis. Three-year overall survival (OS), progression-free survival (PFS), and local control (LC) rate were 44.4%, 38.9%, and 87.8%, respectively. Distant metastasis was the most frequent site of first relapse after HDR-ISBT. One and four patients experienced grade 3 and 2 rectal bleeding, one grade 2 cystitis, and two grade 2 vaginal ulcer.ConclusionsFeasibility and favorable local control of interstitial brachytherapy for locally advanced cervical cancer was demonstrated through a single institutional experience with a small number of patients.

Walking Disability in Patients with Pelvic Insufficiency Fracture after Radiotherapy for Uterine Cervical Cancer.

Radiotherapy is an essential component of curative or palliative therapy for patients with uterine cervical cancer. Although advances in radiotherapy have led to longer survival, survivors may consequently be at risk of pelvic insufficiency fracture (PIF). We retrospectively reviewed medical records and clinical outcomes to assess the impact of PIF on walking disability. Between January 2002 and December 2009, 145 uterine cancer patients treated with radiotherapy in our hospital were reviewed. Among these, 15 patients (10.3%) were diagnosed with PIF. The types of fractures were identified according to the AO/OTA classification system. Medical records were examined to establish the time to first diagnosis of PIF, the type of fracture, and clinical outcomes. Disability was assessed using Barthel index mobility scores. The median time to PIF detection was 16 months. Of the 15 patients with PIF, 14 had type B fractures (7 cases of B2 and 7 cases of B3) and 1 had a type C fracture. Among 11 patients with pelvic pain, 6 achieved pain control but 5 patients with bilateral lesions in the posterior arch or lateral compression of the sacrum developed pain that finally resulted in walking disability and a lower performance status. PIF causes severe motor disturbance in patients with unstable fracture types. Routine imaging checkups were useful during the 5 years after completion of radiotherapy; in nine patients the fracture progressed for longer than 1 year. In cancer rehabilitation for PIF patients, continuous assessment is essential for predicting walking disability.

274P ERCC1 expression predicts treatment response and survival in advanced uterine cervical cancer patients treated with platinum-based chemotherapy

274P ERCC1 expression predicts treatment response and survival in advanced uterine cervical cancer patients treated with platinum-based chemotherapy

Prognostic Significance of Tumor Metabolism in Early Uterine Cervical Cancer Patients Treated With Radical Surgery and Postoperative Radiation Therapy

Prognostic Significance of Tumor Metabolism in Early Uterine Cervical Cancer Patients Treated With Radical Surgery and Postoperative Radiation Therapy

Lowering the Cumulative Central Dose Using Midline Block According to Tumor Response May Reduce Rectal Toxicity Without Compromising Treatment Outcome in Definitive Radiation Therapy for Uterine Cervical Cancer Patients

Lowering the Cumulative Central Dose Using Midline Block According to Tumor Response May Reduce Rectal Toxicity Without Compromising Treatment Outcome in Definitive Radiation Therapy for Uterine Cervical Cancer Patients

Abstract 3726: Race-based disparities in loss of functional independence after uterine cancer

Abstract Introduction Racial disparities in uterine cancer-related outcomes have been reported. Black uterine cancer patients are more likely to have worse clinical outcomes, which are not fully explained by number of comorbidities. Few studies have investigated the factors that may influence functional independence following surgery for uterine cancer. The goal of this study was to determine if race, preoperative body mass index (BMI) and medical comorbidities are predictors of loss of functional independence. Method: Data from the 2011 and 2012 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) were used. All patients were identified by post-operative ICD-9 code. Functional independence was defined as: the patient not requiring assistance from another person for any activities of daily living preoperatively. Loss of independence was defined as requiring discharge to a post-care facility or death, in the immediate postoperative period following hysterectomy. Demographic factors, comorbidities, BMI, intraoperative and postoperative outcomes and discharge status were captured within 30 days of surgery. Statistical analyses included multivariate logistic regression and Wald tests for interaction. Results: 4115 patients were identified with a diagnosis of uterine cancer and were functionally independent preoperatively: 310 (7.5%) were Black and 3805 (92.5%) were non-black. Compared with non-black, Black uterine cancer patients were notable for greater BMI (median 35.4 vs. 32.3, P&amp;lt;0.001), more likely to have one or more comorbidities (76.9% vs. 59.8%, P&amp;lt;0.001), and longer operative time (179.9 mins vs. 159.5 mins, P&amp;lt;0.001). After adjusting for BMI, age, number of comorbidities, pre-operative conditions, major complications, disseminated cancer and days of hospitalization prior to surgery, Black women were not significantly more likely to lose functional independence during the postoperative period than non-Black women. However, a significant interaction (OR 1.14 per 1-unit BMI increase, P&amp;lt;0.001) was found between Black and BMI on loss of functional independence. Interaction plots revealed worse functional outcomes per unit increase in BMI for Black women but not in non-Blacks. Conclusions: The significant interaction between Black race and BMI suggests a 14% increased odds of losing functional independence for each unit of BMI increase for Black uterine cancer patients, meaning that a 10-point increase in BMI would confer a 140% increase in odds of losing functional independence. Black uterine cancer patients with high BMIs may especially benefit from weight loss or interventions to optimize physical function and comorbidity profiles prior to and following surgery, in order to reduce the likelihood of losing functional independence after surgery. Together these efforts may improve disease specific as well as overall health outcomes in Black women with uterine cancer. Citation Format: Lorraine Dean, Xiaochen Zhang, Nawar Latif, Ashley Haggerty, Robert Giuntoli, Sarah Kim, David Shalowitz, Caitlin Stashwick, Mark Morgan, Emily Ko, Kathryn Schmitz. Race-based disparities in loss of functional independence after uterine cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3726. doi:10.1158/1538-7445.AM2015-3726

Value of 18F-FDG PET/CT in patients with cancer of the uterine cervix having elevated serum squamous cell carcinoma antigen after treatment

Objective To evaluate the clinical value of 18F-FDG PET/CT in the detection of residual, recurrent and metastatic diseases in post-treatment uterine cervical cancer patients presenting with elevated serum squamous cell carcinoma (SCC) antigen levels. Methods Between March 2009 and October 2012, 18F-FDG PET/CT was performed in 48 patients(average age (47.5±11.2) years) with suspected residual, recurrent or metastatic uterine cervical cancer because of increased serum SCC antigen level (>1.5 μg/L). The final diagnosis was established by pathology or more than 1 year of clinical follow-up. The diagnostic efficiency of 18F-FDG PET/CT was calculated. Two-sample t test was used for data analysis. Results The serum SCC levels were 1.6-42.5(mean: 8.6±9.4) μg/L. Among the 48 patients, 45 (93.75%) were confirmed of having malignant lesions. 18F-FDG PET/CT along with other imaging detected 174 lesions, of which 169 were proven as residual, recurrent or metastatic diseases. 18F-FDG PET/CT correctly identified 159 lesions, yielding a diagnostic sensitivity and accuracy of 94.08%(159/169) and 91.38%(159/174), respectively. The diagnostic sensitivity and accuracy for residual and recurrent diseases were both 9/10; for lymph node metastasis were 94.59%(105/111) and 92.92%(105/113), respectively; and for other sites of metastasis were 93.75% (45/48) and 88.24%(45/51), respectively. There was no significant difference of SUVmax between the patients with residual/recurrent disease (mean: 6.9±3.8, range: 2.0-13.7) and those with metastasis (mean: 6.3±2.7, range: 2.0-14.4,t=0.629, P>0.05). Conclusion 18F-FDG PET/CT is valuable for the detection of residual, recurrent and metastatic diseases in the uterine cervical cancer patients presenting with elevated serum squamous cell carcinoma antigen after conventional treatment. Key words: Cervix neoplasms; Neoplasm recurrence, local; Neoplasm metastasis; Antigens; Tomography, emission-computed; Tomography, X-ray computed; Deoxyglucose

Association of Educational Levels with Survival in Indian Patients with Cancer of the Uterine Cervix

The main objective of this paper was to assess the influence of educational level on the survival of uterine cervix cancer patients in our population. A total of 224 patients were registered in our registry, of which 178 had information on stage and different educational levels. The overall median survival (MS) was 23 months, with values of 18.5, 20.7 and 41.3 months for the illiterate, literate and qualified groups, respectively. In the illiterate patients, stage I was seen in 2.6% and stage IV in 11.8%, while in other 2 groups stage I was seen in 10% to 17% of patients at the time of diagnosis. The survival probability at around 50 months was around 42%, 30% and 26% (approximately) for qualified, literates and illiterates respectively [Log Rank (Mantel-Cox) showed p=0.023]. Emphasis on imparting education to females can be a part of comprehensive cancer control programme for improving the overall survival in patients with carcinoma of the uterine cervix in our population.

Tailored radiotherapeutic strategies for disseminated uterine cervical cancer patients.

BackgroundTo investigate the role of radiotherapy (RT) in and to suggest radiotherapeutic strategies for patients presenting with disseminated cervical cancer.MethodsWe retrospectively analyzed 50 patients diagnosed as the disseminated cervical cancer with distant lymph nodal or visceral organ metastasis between September 1980 and August 2012. Patients were divided into two subgroups according to visceral organ metastasis: 35 patients diagnosed with distant lymph node metastasis only (group A) and 15 patients with visceral organ metastasis (group B). All patients received external beam RT to the pelvis (median dose 45 Gy) and high-dose rate intracavitary RT (median dose 30 Gy). Thirty-nine patients (78%) received chemotherapy.ResultsMedian follow-up time was 74 months. The 5-year pelvic control rate (PCR) was 85.8%, and the progression-free survival (PFS), and overall survival (OS) rates were 28.7%, and 36.2%, respectively. The major treatment failure was systemic progression (32 patients, 64%). The 5-year PCRs in groups A and B were 87.4% and 74.7%, respectively (p > 0.05). Meanwhile, PFS and OS rates for group A were significantly better than those for group B (35.3% vs. 13.3%, p = 0.010; and 46.3% vs. 13.3%, p = 0.009, respectively).ConclusionOur data revealed considerable prognostic heterogeneity in disseminated cervical cancer. Even though a high PCR was achieved in patients treated with definitive RT, survival outcomes were dependent on progression of visceral organ metastasis. Therefore, personalized RT and chemotherapy treatment strategies according to the presence of visceral organ metastasis in disseminated cervical cancer patients may help improve clinical outcomes.

Factors associated with low educational background in uterine cancer patients

Objectives: To investigate the feasibility of counseling obese endometrial cancer survivors by exploring data from the National Cancer Database to identify factors associated with education levels in uterine cancer patients.

Preoperative imaging of uterine malignancy: A low-value service

ObjectiveThe aim of this study is to examine the value of computed tomography (CT) or magnetic resonance imaging (MRI) before surgical treatment of uterine malignancy. MethodsRetrospective chart review was undertaken of women who underwent hysterectomy for uterine cancer at the University of Virginia. Radiologic reports were examined for evidence of cervical or extrauterine disease or incidental findings and correlated with detection of extrauterine disease at surgery. ResultsOverall, 204 of 448 patients (45%) had preoperative imaging. Scans were ordered nearly evenly by referring clinicians and gynecologic oncologists (GO) (95 vs. 122, 44% vs. 56%). Imaging was most common among patients with grade 3 endometrioid or non-endometrioid histology (86 of 101, 85%). Women referred with low grade disease had more false positive (4 of 112, 4%) than true positive scans (2 of 113, 2%). Overall, 23 of 190 (12%) reviewed preoperative scans indicated suspected extrauterine disease. Two of these 23 women were low risk by intra-operative "Mayo criteria" and had stage 1A disease; 14 of 23 (61%) had stage II or greater disease. ConclusionsPreoperative CT or MRI is of low value in predicting extra-uterine disease among uterine cancer patients with low grade disease. Women with low grade disease had false positive results more frequently than true detection of extrauterine disease. Abnormal imaging findings are more common and predictive of extrauterine disease in women with grade 3 or non-endometrioid histology but the value of these scans remains unclear.

Comparison of lower extremity lymphedema incidence between two pelvic lymphadenectomy techniques in uterine cancer patients undergoing robotic-assisted staging procedures

Objectives: To compare the difference in incidence of lower extremity lymphedema after robotic surgical staging for uterine cancer employing standard pelvic lymphadenectomy and selective pelvic lymphadenectomy with sparing of the lateral external iliac chain as well as to evaluate the adequacy of selective approach in detecting lymph node metastases.

Class III beta-tubulin expression in uterine cancer correlates with worse outcomes

Objectives: Increased tumor expression of the class III beta-tubulin isotype (b3T), correlates with poor clinical outcomes in patients with various malignancies. Our objective was to determine the association between b3T expression and clinical outcomes in uterine cancer patients treated with chemotherapy.

Screening for germline phosphatase and tensin homolog-mutations in suspected Cowden syndrome and Cowden syndrome-like families among uterine cancer patients.

Cowden syndrome (CS) is an autosomal dominant disorder characterized by multiple hamartomas in the breast, thyroid and endometrium, with a prevalence of 1 per 250,000. Females with CS have a 21–28% lifetime risk of developing uterine cancer. Germline mutations in the phosphatase and tensin homolog (PTEN) gene, a tumor suppressor gene, are responsible for 30–80% of CS cases. PTEN is a nine-exon gene, located on chromosome 10q23.3, which encodes the 403 amino acid PTEN protein. It negatively regulates the phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin pathway, affecting various cellular processes and signaling pathways. The present study examined whether PTEN mutations are present in CS-like families with uterine cancer (UC). UC patients underwent surgery at Karolinska University Hospital, Stockholm, Sweden (2008–2012). Pedigrees were analyzed and 54 unrelated CS-like families were identified. CS-like families were defined as having at least one occurrence of uterine cancer and one of breast cancer, as well as at least one additional Cowden-associated tumor (uterine, breast, thyroid, colon or kidney cancer) in the same individual or in first-degree relatives. Genomic DNA was amplified using polymerase chain reaction, and DNA sequencing analysis of all nine exons of the PTEN gene was conducted. No germline PTEN mutations or polymorphisms were identified. Germline PTEN mutations are rare in CS-like families with uterine cancer, therefore, genetic screening must be restricted to patients that meet the strict National Comprehensive Cancer Network criteria. Gynecologists must be aware of the CS criteria and identify potential cases of CS in females where uterine cancer is the sentinel cancer.