Vol 94, No 4 (2023)
Research paper
Published online: 2022-10-10

open access

Page views 2300
Article views/downloads 627
Get Citation

Connect on Social Media

Connect on Social Media

Endometrial carcinoma in patients under 40 years of age: insights from the Bulgarian Cancer Registry

Angel Yordanov1, Stoyan Kostov2, Yavor Kornovski23, Stanislav Slavchev23, Yonka Ivanova23, Jean Calleja-Agius4, Riccardo Di Fiore45, Sherif Suleiman4, Andra Piciu6, Ihsan Hasan7, Mariela Vasileva-Slaveva89
Pubmed: 37431249
Ginekol Pol 2023;94(4):275-282.

Abstract

Objectives: We aimed to investigate the overall survival (OS) of young women with endometrial cancer (EC) in Bulgaria and the impact of histological type on survival.
Material and methods: This is a population-wide retrospective study of patients with EC (≤ 40 years at diagnosis) registered at Bulgarian National Cancer Registry (BNCR) between 1993 and 2020. Patients were re-classified according to the 8th edition of the TNM classification.
Results: In total, 30 597 patients were registered and histologically confirmed with malignant tumors of the uterine body. From that, 29 065 of them (95%) had ECs, and the rest had sarcomas. Around 1.64% of all malignant tumors of the uterine body are diagnosed in women under the age of 40. Most of them are diagnosed in the early stage. There was no significant difference in median OS for patients diagnosed before or after 2003. In recent years there was a slight improvement in survival and patients from the last cohort of this study had a 5-year survival rate of 92.5%. Patients with favorable pathology (T1, G1/2) had no lymph node involvement at the time of diagnosis and their 10-year survival rate was 94%.
Conclusions: EC in young women is a rare disease. In most cases, patients are diagnosed in early stageT1, G1/2, N0 and their prognosis is excellent. However, the lack of improvement of OS of young patients with EC in the last three decades shows the need for treatment optimization.

Article available in PDF format

View PDF Download PDF file

References

  1. Global Cancer observatory. Cancer today. Fact sheets – uterine corpus 2020. https://gco.iarc.fr/today/data/factsheets/cancers/24-Corpus-uteri-fact-sheet.pdf (05.06.2022).
  2. Son Ji, Carr C, Yao M, et al. Endometrial cancer in young women: prognostic factors and treatment outcomes in women aged ≤40 years. Int J Gynecol Cancer. 2020; 30(5): 631–639.
  3. Major FJ, Blessing JA, Silverberg SG, et al. Prognostic factors in early-stage uterine sarcoma. A Gynecologic Oncology Group study. Cancer. 1993; 71(4 Suppl): 1702–1709.
  4. El-Khalfaoui K, du Bois A, Heitz F, et al. Current and future options in the management and treatment of uterine sarcoma. Ther Adv Med Oncol. 2014; 6(1): 21–28.
  5. Trojano G, Olivieri C, Tinelli R, et al. Conservative treatment in early stage endometrial cancer: a review. Acta Biomed. 2019; 90(4): 405–410.
  6. Cicchillitti L, Corrado G, Carosi M, et al. Lamin A as novel molecular prognostic biomarker in endometrioid endometrial cancers. It J Gynaecol Obstet. 2016; 28(2): 57–65.
  7. Bogani G, Dowdy SC, Cliby WA, et al. Management of endometrial cancer: issues and controversies. Eur J Gynaecol Oncol. 2016; 37(1): 6–12.
  8. Caponio MA, Addati T, Popescu O, et al. P16(INK4a) protein expression in endocervical, endometrial and metastatic adenocarcinomas of extra-uterine origin: diagnostic and clinical considerations. Cancer Biomark. 2014; 14(2-3): 169–175.
  9. Amant F, Trum H, Vergote I, et al. Endometrial cancer. Lancet. 2005; 366(9484): 491–505.
  10. Duska LR, Garrett A, Rueda BR, et al. Endometrial cancer in women 40 years old or younger. Gynecol Oncol. 2001; 83(2): 388–393.
  11. Evans-Metcalf ER, Brooks SE, Reale FR, et al. Profile of women 45 years of age and younger with endometrial cancer. Obstet Gynecol. 1998; 91(3): 349–354.
  12. Gitsch G, Hanzal E, Jensen D, et al. Endometrial cancer in premenopausal women 45 years and younger. Obstet Gynecol. 1995; 85(4): 504–508.
  13. Colafranceschi M, Taddei GL, Scarselli G, et al. Clinico-pathological profile of endometrial carci-noma in young women (under 40 years of age). Eur J Gynaecol Oncol. 1989; 10(5): 353–356.
  14. Crissman JD, Azoury RS, Barnes AE, et al. Endometrial carcinoma in women 40 years of age or younger. Obstet Gynecol. 1981; 57(6): 699–704.
  15. Ota T, Yoshida M, Kimura M, et al. Clinicopathologic study of uterine endometrial carcinoma in young women aged 40 years and younger. Int J Gynecol Cancer. 2005; 15(4): 657–662.
  16. Cancer Registry Annualy Report, 2008. Taiwan: Bureau of Health Promotion, Department of Health, The Executive Yuan 2010.
  17. Keys HM, Roberts JA, Brunetto VL, et al. Gynecologic Oncology Group. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2004; 92(3): 744–751.
  18. Soliman PT, Oh JC, Schmeler KM, et al. Risk factors for young premenopausal women with endometrial cancer. Obstet Gynecol. 2005; 105(3): 575–580.
  19. Gallup DG, Stock RJ. Adenocarcinoma of the endometrium in women 40 years of age or younger. Obstet Gynecol. 1984; 64(3): 417–420.
  20. Pellerin GP, Finan MA. Endometrial cancer in women 45 years of age or younger: a clinicopathological analysis. Am J Obstet Gynecol. 2005; 193(5): 1640–1644.
  21. Valerianova Z, Dimitrova N, Tonev S, Vukov M. Cancer Incidence in Bulgaria, 2012. Bulgarian National Cancer Registry, Sofia 2014.
  22. Global Cancer Observatory CANCER OVER TIME |IARC - All Rights Reserved 2022 - Data version: 1.0 International Agency for Research on Cancer 1994 1996 Acess date 12th of June 2022.
  23. Lee NK, Cheung MK, Shin JY, et al. Prognostic factors for uterine cancer in reproductive-aged women. Obstet Gynecol. 2007; 109(3): 655–662.
  24. Shah MM, Wright JD. Management of endometrial cancer in young women. Clin Obstet Gynecol. 2011; 54(2): 219–225.
  25. Smith M, McCartney AJ. Occult, high-risk endometrial cancer. Gynecol Oncol. 1985; 22(2): 154–161.
  26. Brown AJ, Westin SN, Broaddus RR, et al. Progestin intrauterine device in an adolescent with grade 2 endometrial cancer. Obstet Gynecol. 2012; 119(2 Pt 2): 423–426.
  27. Rose PG, Mendelsohn G, Kornbluth I. Hysteroscopic dissemination of endometrial carcinoma. Gynecol Oncol. 1998; 71(1): 145–146.
  28. Rodolakis A, Biliatis I, Morice P, et al. European Society of Gynecological Oncology Task Force for Fertility Preservation: Clinical Recommendations for Fertility-Sparing Management in Young Endometrial Cancer Patients. Int J Gynecol Cancer. 2015; 25(7): 1258–1265.
  29. Ramirez PT, Frumovitz M, Bodurka DC, et al. Hormonal therapy for the management of grade 1 endometrial adenocarcinoma: a literature review. Gynecol Oncol. 2004; 95(1): 133–138.
  30. Ushijima K, Yahata H, Yoshikawa H, et al. Multicenter phase II study of fertility-sparing treatment with medroxyprogesterone acetate for endometrial carcinoma and atypical hyperplasia in young women. J Clin Oncol. 2007; 25(19): 2798–2803.
  31. La Rosa VL, Garzon S, Gullo G, et al. Fertility preservation in women affected by gynaecological cancer: the importance of an integrated gynaecological and psychological approach. Ecancermedicalscience. 2020; 14: 1035.
  32. Walsh C, Holschneider C, Hoang Y, et al. Coexisting ovarian malignancy in young women with endometrial cancer. Obstet Gynecol. 2005; 106(4): 693–699.
  33. Zaino R, Whitney C, Brady MF, et al. Simultaneously detected endometrial and ovarian carcinomas--a prospective clinicopathologic study of 74 cases: a gynecologic oncology group study. Gynecol Oncol. 2001; 83(2): 355–362.
  34. Zaino RJ, Unger ER, Whitney C. Synchronous carcinomas of the uterine corpus and ovary. Gynecol Oncol. 1984; 19(3): 329–335.
  35. Eifel P, Hendrickson M, Ross J, et al. Simultaneous presentation of carcinoma involving the ovary and the uterine corpus. Cancer. 1982; 50(1): 163–170, doi: 10.1002/1097-0142(19820701)50:1<163::aid-cncr2820500131>3.0.co;2-k.
  36. Soliman PT, Slomovitz BM, Broaddus RR, et al. Synchronous primary cancers of the endometrium and ovary: a single institution review of 84 cases. Gynecol Oncol. 2004; 94(2): 456–462.
  37. Wright JD, Buck AM, Shah M, et al. Safety of ovarian preservation in premenopausal women with endometrial cancer. J Clin Oncol. 2009; 27(8): 1214–1219.
  38. ACOG. ACOG Practice Bulletin No. 89. Elective and risk-reducing salpingo-oophorectomy. Obstet Gynecol. 2008; 111(1): 231–241.
  39. CIA World Factbook URL. https://www.indexmundi.com/g/g.aspx?c=bu&v=2228 (31.05.2021).
  40. Della Corte L, Giampaolino P, Mercorio A, et al. Sentinel lymph node biopsy in endometrial cancer: state of the art. Transl Cancer Res. 2020; 9(12): 7725–7733.