Cellular Classification of Endometrial Cancer
The most common endometrial cancer cell type is endometrioid adenocarcinoma, which is composed of malignant glandular epithelial elements; an admixture of squamous metaplasia is not uncommon. Adenosquamous tumors contain malignant elements of both glandular and squamous epithelium; clear cell and papillary serous carcinoma of the endometrium are tumors that are histologically similar to those noted in the ovary and the fallopian tube, and the prognosis is worse for these tumors. Mucinous, squamous, and undifferentiated tumors are rarely encountered. Frequency of endometrial cancer cell types is as follows: Endometrioid (75%–80%). Ciliated adenocarcinoma.Secretory adenocarcinoma.Papillary or villoglandular.Adenocarcinoma with squamous differentiation.Adenoacanthoma.Adenosquamous.Uterine papillary serous (<10%).Mucinous (1%).Clear cell (4%).Squamous cell (<1%).Mixed (10%).Undifferentiated.References: Zaino RJ, Kurman R, Herbold D, et al.: The significance of squamous
Stage IIA Cervical Cancer
Either radiation therapy or radical hysterectomy results in cure rates of 75% to 80%. The selection of either option depends on patient factors and local expertise. A randomized trial reported identical 5-year overall survival (OS) and disease-free survival rates when radiation therapy was compared with radical hysterectomy. The size of the primary tumor is an important prognostic factor and should be carefully evaluated in choosing optimal therapy. For patients with bulky (>6 cm) endocervical squamous cell carcinomas or adenocarcinomas, treatment with high-dose radiation therapy will achieve local control and survival rates comparable to treatment with radiation therapy plus hysterectomy. Surgery after radiation therapy may be indicated for some patients with tumors confined to the cervix that respond incompletely to radiation therapy or in whom vaginal anatomy precludes optimal brachytherapy. After surgical staging, patients found to have small volume para-aortic nodal
General Information About Cervical Cancer
Cervical cancer is a disease in which malignant (cancer) cells form in the cervix.The cervix is the lower, narrow end of the uterus (the hollow, pear-shaped organ where a fetus grows). The cervix connects the uterus to the vagina (birth canal). Anatomy of the female reproductive system. The organs in the female reproductive system include the uterus, ovaries, fallopian tubes, cervix, and vagina. The uterus has a muscular outer layer called the myometrium and an inner lining called the endometrium. Cervical cancer usually develops slowly over time. Before cancer appears in the cervix, the cells of the cervix go through a series of changes in which cells that are not normal begin to appear in the cervical tissue. When cells change from being normal cells to abnormal cells, it is called dysplasia. Depending on the number of abnormal cells, dysplasia may go away without treatment. The more abnormal cells there are, the less likely they are to go away. Dysplasia that is not treated may
Cellular Classification of Uterine Sarcoma
The most common histologic types of uterine sarcomas include:Carcinosarcomas (mixed mesodermal sarcomas [40%–50%]).Leiomyosarcomas (30%).Endometrial stromal sarcomas (15%).The uterine neoplasm classification of the International Society of Gynecologic Pathologists and the World Health Organization uses the term carcinosarcomas for all primary uterine neoplasms containing malignant elements of both epithelial and stromal light microscopic appearances, regardless of whether malignant heterologous elements are present.References: Silverberg SG, Major FJ, Blessing JA, et al.: Carcinosarcoma (malignant mixed mesodermal tumor) of the uterus. A Gynecologic Oncology Group pathologic study of 203 cases. Int J Gynecol Pathol 9 (1): 1-19, 1990.
Cervical Cancer Screening
Tests are used to screen for different types of cancer.Some screening tests are used because they have been shown to be helpful both in finding cancers early and in decreasing the chance of dying from these cancers. Other tests are used because they have been shown to find cancer in some people; however, it has not been proven in clinical trials that use of these tests will decrease the risk of dying from cancer.Scientists study screening tests to find those with the fewest risks and most benefits. Cancer screening trials also are meant to show whether early detection (finding cancer before it causes symptoms) decreases a person's chance of dying from the disease. For some types of cancer, the chance of recovery is better if the disease is found and treated at an early stage.Clinical trials that study cancer screening methods are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site.Studies show that screening for
Evidence of Harms
Abnormal ultrasound typically requires further investigation including endometrial biopsy (sampling). The evidence is solid that endometrial sampling may result in discomfort, bleeding, infection, and rarely uterine perforation. A study designed to evaluate performance, patient acceptance, and cost-effectiveness of blind biopsy, hysteroscopy with biopsy, and ultrasound, in 683 women with vaginal bleeding, reported that minor events, including discomfort and distress, occurred in 16% of women who had hysteroscopy with biopsy, and in 10% of the women who had a blind biopsy. A group of researchers studied 13,600 diagnostic and operative hysteroscopic procedures and found a lower complication rate among diagnostic procedures (0.13%) compared with operative procedures (0.28%). Risks associated with false-positive test results include anxiety and additional diagnostic testing and surgery. Endometrial cancers may be missed on endometrial sampling and ultrasound.References: Critchley
Summary of Evidence
Separate PDQ summaries on Prevention of Endometrial Cancer; Endometrial Cancer Treatment; and Uterine Sarcoma Treatment are also available. Benefits There is inadequate evidence that screening by ultrasonography (e.g.,transvaginal ultrasound [TVU]) or endometrial sampling would reduce the mortality from endometrial cancer. Description of the Evidence STUDY DESIGN: No studies have adequately ...
Stage Information for Cervical Cancer
Cervical carcinoma has its origins at the squamous-columnar junction whether in the endocervical canal or on the portion of the cervix. The precursor lesion is dysplasia or carcinoma in situ (cervical intraepithelial neoplasia [CIN]), which can subsequently become invasive cancer. This process can be quite slow. Longitudinal studies have shown that in untreated patients with in situ cervical cancer, 30% to 70% will develop invasive carcinoma over a period of 10 to 12 years. However, in about 10% of patients, lesions can progress from in situ to invasive in a period of less than 1 year. As it becomes invasive, the tumor breaks through the basement membrane and invades the cervical stroma. Extension of the tumor in the cervix may ultimately manifest as ulceration, exophytic tumor, or extensive infiltration of underlying tissue including bladder or rectum. In addition to local invasion, carcinoma of the cervix can spread via the regional lymphatics or bloodstream.
Treatment Options for Gestational Trophoblastic Disease
A link to a list of current clinical trials is included for each treatment section. For some types of gestational trophoblastic disease, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.Hydatidiform MolesTreatment of a hydatidiform mole may include the following:Surgery (Dilatation and curettage with suction evacuation) to remove the tumor.After surgery, beta human chorionic gonadotropin (β-hCG) blood tests are done every week until the β-hCG level returns to normal. Patients also have follow-up doctor visits monthly for up to 6 months. If the level of β-hCG does not return to normal or increases, it may mean the hydatidiform mole was not completely removed and it has become cancer. Pregnancy causes β-hCG levels to increase, so your doctor will ask you not to become pregnant until follow-up is finished.For disease that remains after surgery, treatment is usually chemotherapy.Check for U.S. clinical
General Information About Gestational Trophoblastic Disease
Gestational trophoblastic disease (GTD) is a broad term encompassing both benign and malignant growths arising from products of conception in the uterus. GTD may be classified as follows:Hydatidiform mole (HM).Complete HM.Partial HM.Gestational trophoblastic neoplasia.Invasive mole.Choriocarcinoma.Placental-site trophoblastic tumor (very rare).Epithelioid trophoblastic tumor (even more rare).The reported incidence of GTD varies widely worldwide, from a low of 23 per 100,000 pregnancies (Paraguay) to a high of 1,299 per 100,000 pregnancies (Indonesia). However, at least part of this variability is caused by differences in diagnostic criteria and reporting. The reported incidence in the United States is about 110 to 120 per 100,000 pregnancies. The reported incidence of choriocarcinoma, the most aggressive form of GTD, in the United States is about 2 to 7 per 100,000 pregnancies. The U.S. age-standardized (1960 World Population Standard) incidence rate of choriocarcinoma is