Uterine serous carcinoma, also known as Uterine papillary serous carcinoma.
A subtype of endometrial carcinoma with distinctive microscopic features and an unusually high rate of relapse.
Associated with more lymphatic invasion, deep myometrial invasion, lymph nodes metastases and worse outcome, even when statistically corrected for stage.
Resembles its ovarian counterpart in morphology and propensity for transperitoneal metastases.
Uterine serous carcinoma, also known as Uterine papillary serous carcinoma.
Uterine serous carcinoma is a malignant form of serous tumor that is is an uncommon form of endometrial cancer that typically arises in postmenopausal women.
It is typically diagnosed on endometrial biopsy, prompted by post-menopausal bleeding.
Unlike the more common low-grade endometrioid endometrial adenocarcinoma, uterine serous carcinoma does not develop from endometrial hyperplasia and is not hormone-sensitive.
It arises in the setting of endometrial atrophy and is classified as a type II endometrial cancer.
There is usually a precursor lesion called serous endometrial intraepithelial carcinoma.
Mutation is found in TP53 gene which is a tumor suppressor gene.
Many missense mutation and mutation in PI3K and PP2A genes are involved which also contribute to this tumor.
The lesion is found in patients who present typically with abnormal or postmenopausal bleeding.
Uterine serous carcinomas is typically characterized by papillae with fibrovascular cores, marked nuclear atypia, psammoma bodies and cilia.
These are general findings in serous tumors which are also seen in such tumors in other anatomic locations.
Uterine papillary serous carcinoma is staged like other forms of endometrial carcinoma at time of surgery using the International Federation of Gynecology and Obstetrics cancer staging system.
Stage IA: tumor is limited to less than half the myometrium Stage IB: invasion of more than half the myometrium Stage II: cervical stromal invasion Stage IIIA: tumor invades serosa or adnexa Stage IIIB: vaginal or parametrial metastasis Stage IIIC1: metastasis to pelvic lymph nodes Stage IIIC2: metastasis to para-aortic lymph nodes Stage IVA: invasion of the bladder or bowel Stage IVB: distant metastasis, including intra-abdominal or inguinal lymph nodes
In the older literature survival rates have been given as 35–50% for stage I–II and 0–15% for stage III and IV uterine papillary serous carcinoma.
More recently it was reported that forty-two percent of 138 patients were found disease-free at five years.
The primary treatment is surgical.
FIGO-cancer staging is done at the time of surgery which consists of peritoneal cytology, total hysterectomy, bilateral salpingo-oophorectomy, pelvic/para-aortic lymphadenectomy, and omentectomy.
Uterine papillary serous carcinoma is aggressive and spreads quickly into the myometrium and the lymphatic system.
If the tumor has spread surgery is cytoreductive followed by radiation therapy and/or chemotherapy.
Uterine serous carcinoma (USC), an aggressive subtype of endometrial cancer, and requires a multimodal approach due to its high propensity for recurrence and poor prognosis.
Surgery: staging, including hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection, is the initial step.
Optimal cytoreduction is crucial for improving outcomes.
Adjuvant Chemotherapy with Platinum/taxane-based chemotherapy is recommended for both early and advanced stages.
This regimen has been shown to improve overall survival and reduce recurrence rates.
Adjuvant radiotherapy, particularly vaginal cuff brachytherapy, is often used to control loco-regional disease.
Radiotherapy is beneficial in reducing pelvic recurrences, especially when combined with chemotherapy.
For advanced or recurrent USC, targeted therapies such as trastuzumab for HER2/neu-positive tumors and immunotherapy with PD-1 inhibitors in combination with lenvatinib have shown promise.
Despite aggressive treatment, USC has a poor prognosis.
The 5-year overall survival rates vary significantly by stage, with early-stage disease having better outcomes compared to advanced stages.
Recurrence rates remain high, particularly with distant metastases.
With stage I uterine papillary serous carcinoma who had undergone surgery, no increased survival was seen when radiation therapy was added versus observation, while the postsurgical treatment with chemotherapy may be beneficial but more data are needed.
Patients with stage 1A who had no residual disease in the hysterectomy specimen had no recurrence regardless if chemotherapy was used or not, however, patients with stage 1A disease with residual disease in the hysterectomy specimen had no recurrence with platinum-based therapy, but those who had no such chemotherapy showed recurrence in 43%.
Similarly, patients with stage 1B disease with chemotherapy had no recurrence, while those without chemotherapy had a high degree (77%) of recurrence.
About 60% of uterine serous carcinomas were found to overexpress the protein HER2/neu.
The monoclonal antibody trastuzumab (Herceptin) is currently being tested as a therapy for this subset of uterine serous carcinomas.
Prognosis of uterine papillary serous carcinoma is affected by age, stage, and histology as well as treatment.
Represents only 1-12% of endometrial carcinomas.
5-year survival rate 66%.
5-year survival for stage I disease 72%
5-year survival for stage II disease is 51%.
Often resistant to chemotherapy from onset, low response rates with chemotherapy, short response durations, and the five-year survival rate of 18% for stage IV disease.