Uterine Cancer

Diagnosis

Uterine cancer. Ovarian cancer. Endometrial Serous Carcinoma. Condition following removal of the uterus and appendages. Enlargement of retroperitoneal lymph nodes. 

Patient complaints

After removal of the uterus, the condition improved, and no local recurrence of the tumour was found. However, MRI images of the abdominal organs taken one month after the surgery showed enlargement of the retroperitoneal lymph nodes.

An immunohistochemical test was recommended to determine the histological type of the tumour and the surrogate molecular subtype.

Histological examination revealed high-grade serous endometrial carcinoma with invasion into the myometrium. According to the laboratory that performed the initial histological analysis of the tumour, the tumour type corresponds to pMMR, estrogen and progesterone receptors are negative, and p53 mutation was detected.

Reply from gynaecological oncologist Dr. Jörg Falbrede

I have carefully analysed the patient's situation, considering the results of the immunohistochemical examination.

Stage of the disease: highly aggressive serous endometrial carcinoma pT3 cN+ (aorta?) Figo III (IV) = progressive serous endometrial carcinoma.

Biology

• p53 protein mutation — all cells with negative status are therefore mutated (!) and should be considered p53-positive (!).
• pMMR — mismatch repair genes are functioning and are therefore active.
• E (-), P (-) — estrogen and progesterone receptors are negative, which is typical for serous endometrial carcinoma. 
• Ki67-70% — a very aggressive tumor that grows rapidly, according to the high Ki67 value.

I have attached my presentation materials and slides on this topic. Based on this data, conclusions can be made about current treatment recommendations.

• The AtTEnd study by Prof. Dr. Nicoletta Colombo, presented at the ESMO Congress in Madrid in 2023, didn't show any clear benefits from using checkpoint inhibitors (CPI) in pMMR tumors, like in this case.
• The side effects of these very expensive drugs are quite severe. 
• Therapy must be supervised by highly experienced specialists!!!
• The AtTEnd study did not show any advantage of using checkpoint inhibitors.
• The Duo E study is attempting to prove the advantage, but the results are still very insignificant. 
• There is a high risk of side effects.
• The increase in the period before recurrence does not exceed 3 months.

After analyzing all of the above data, I keep to my main recommendation based on current research: 6 cycles of chemotherapy using carboplatin AUC 5 and paclitaxel 175 mg/m² every 3 weeks. 

Therapy using the PORTEC protocol can be considered a secondary recommendation, but it does not improve the survival prognosis. Most likely, only the rate of local recurrence will decrease. In the event of a recurrence (which is likely to occur), a new approach will need to be considered. Unfortunately, the overall prognosis is unfavorable. 

The treatment examples presented on our website are for informational purposes only and should not be used as medical recommendations. Medications should only be used as prescribed by a doctor.