Uterine clear cell carcinoma


Uterine clear cell carcinoma
Uterine clear cell carcinoma
Classification and external resources
ICD-10 C54.1
ICD-9 182

Uterine clear cell carcinoma (CC) is a rare form of endometrial cancer with distinct morphological features on pathology; it is aggressive and has high recurrence rate. Like uterine papillary serous carcinoma CC does not develop from endometrial hyperplasia and is not hormone sensitive, rather it arises from an atrophic endometrium. Such lesions belong to the type II endometrial cancers.[1]

Contents

Diagnosis

The lesion is found in patients who present typically with abnormal or postmenopausal bleeding. Such bleeding is followed by further evaluation leading to a tissue diagnosis, usually done by a dilatation and curettage (D&C). A work-up to follow would look for metastasis using imaging technology including sonography and MRI. The median age at diagnosis in a large study was 66 years.[2] Histologically the lesion may coexist with classical endometrial cancer.

Prognosis and treatment

Prognosis of the CC is affected by age, stage, and histology as well as treatment

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. The tumor is aggressive and spreads quickly into the myometrium and the lymphatic system. Thus even in presumed early stages, lymphadenectomy and omentectomy should be included in the surgical approach. If the tumor has spread surgery is cytoreductive followed by radiation therapy and/or chemotherapy.[2][3]

The five years survival was reported to be 68%.[2]

Staging

UPSC is staged like other forms of endometrial carcinoma at time of surgery using the FIGO cancer staging system.

  • Stage IA: tumor is limited to the endometrium
  • Stage IB: invasion of less than half the myometrium
  • Stage IC: invasion of more than half the myometrium
  • Stage IIA: endocervical glandular involvement only
  • Stage IIB: cervical stromal invasion
  • Stage IIIA: tumor invades serosa or adnexa, or malignant peritoneal cytology
  • Stage IIIB: vaginal metastasis
  • Stage IIIC: metastasis to pelvic or para-aortic lymph nodes
  • Stage IVA: invasion of the bladder or bowel
  • Stage IVB: distant metastasis, including intraabdominal or inguinal lymph nodes

References

  1. ^ Gründker C, Günthert AR, Emons G. (2008). "Hormonal heterogeneity of endometrial cancer.". Adv Exp Med Biol. 2008;630:166-88. 630: 166–88. doi:10.1007/978-0-387-78818-0_11. PMID 18637491. 
  2. ^ a b c C A Hamilton, M K Cheung, K Osann, L Chen, N N Teng, T A Longacre, M A Powell, M R Hendrickson, D S Kapp and J K Chan. "Uterine papillary serous and clear cell carcinomas predict for poorer survival compared to grade 3 endometrioid corpus cancers.". British Journal of Cancer (2006) 94, 642–646.. 
  3. ^ Stanojevic Z, Djordjevic B, Todorovska I, Lilic V, Zivadinovic R, Dunjic O. (2008). "Risk factors and adjuvant chemotherapy in the treatment of endometrial cancer.". J BUON. 2008 Jan-Mar;13(1):23-30. 13 (1): 23–30. PMID 18404782. 

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