Treatment of uterine carcinomas

Uterine epithelial cancers are the most common type of gynecologic cancer in the United States. The American Cancer Society estimated 53,000 new cases of uterine cancers in 2014 with 8,600 deaths from advanced or recurrent cases, 99% of which are endometrial cancer. The 5-year survival rate of low-stage, low-grade endometrioid adenocarcinoma is greater than 90%. In contrast, advanced stage endometrioid adenocarcinomas and Type II (serous and carcinosarcoma) endometrial cancers have a much poorer prognosis, with the 5-year survival rate of advanced stage uterine carcinosarcoma as low as 9%. Together, these endometrial cancers with poor prognoses comprise almost half of all cases in the US, creating a significant medical obstacle for management. The authors present a review of endometrial cancer pathology, diagnosis and treatment. Included on the topic of treatment are: surgery, endocrine therapy, and chemotherapy with commentary on pertinent phase II and III clinical trials. The discussion covers single and multi-agent chemotherapy. Also covered are current clinical trials using targeted therapies such as mTOR inhibitors, angiokinase inhibitors, and HER2-directed agents. The review concludes with thoughts on future directions in therapeutic management of this disease.