••• Chapter 44^ Endometrial Hyperplasia and Carcinoma^449
❍ What is the effect of race on the prognosis of endometrial carcinoma?
Compared with white Americans, endometrial cancer incidence is lower in Japanese Americans [relative risk (RR)
= 0.6; 95% confidence interval (CI), 0.46–0.83] and in Latinas (RR = 0.63; 95% CI, 0.46–0.87), but not in African
Americans (RR = 0.76; 95% CI, 0.53–1.08) or in native Hawaiians (RR = 0.92; 95% CI, 0.58–1.46). Higher
mortality from endometrial cancer in African Americans is at least partly attributable to lower socioeconomic issues
that impair access to care.
❍ What is the effect of gross cervical involvement in the prognosis of endometrial cancer?
Gross cervical involvement is associated with a poorer prognosis. When treated with intracavitary application of
cesium followed by extrafascial hysterectomy, the mean survival time in women without gross cervical disease was
94.2 months, compared with 29.1 months for women with gross cervical disease.
❍ What are the two best prognostic indicators of endometrioid endometrial adenocarcinoma?
Histologic grade and depth of myometrial invasion.
❍ What are the differences in frequency and 5-year survival between surgical stage 1 typical endometrioid
adenocarcinoma and papillary serous carcinoma of the endometrium?
Typical endometrioid adenocarcinoma accounts for approximately 80% of endometrial adenocarcinoma. Papillary
serous carcinoma accounts for approximately 8% of all endometrial adenocarcinomas.
The 5-year survival for stage 1 typical endometrioid adenocarcinoma is 88% and that of stage 1 papillary serous
carcinoma is 63%.
❍ Is the quantity of ER and PR higher or lower in endometrial carcinoma as compared with normal cycling
endometrium?
The concentration varies, but with adenocarcinoma the concentration is usually less than normal cycling endometrium.
❍ What is the significance of ER and PR status in the prognosis of women with a diagnosis of endometrial
carcinoma?
ER status does not correlate well with prognosis. The absence of PRs is associated with a poor prognosis.
❍ Which factors or interventions decrease the incidence of endometrial cancer?
Factors that have been associated with a decreased incidence of endometrial cancer include parity, lactation, use of
combined oral contraceptives, a diet low in fat and high in plant foods, and physical activity.
❍ What percentage of women with endometrial carcinoma clinically confined to the uterus will develop
recurrent disease?
Approximately 16%.
❍ What is the average time from diagnosis to recurrence in endometrial carcinoma?
2.2 years.
❍ When endometrial carcinoma recurs, what percentage of recurrence are detected within the first and the
second year?
34% and 70%, respectively.