Simultaneously Detected Endometrial and Ovarian Carcinomas: A Prospective Clinicopathologic Study
Abstract & Commentary
Synopsis: The prognosis for women with simultaneously detected carcinomas in the uterus and ovary with gross disease confined to the pelvis is surprisingly good, particularly for those with disease microscopically limited to the uterus and ovary or of low histologic grade.
Source: Zaino R, et al. Gynecol Oncol. 2001;83: 355-362.
In this prospective clinicopathologic study of the Gynecologic Oncology Group (GOG) conducted between 1985 and 1991, Zaino and colleagues enrolled 85 patients with apparent simultaneously detected adenocarcinomas in the endometrium and ovary with disease grossly confined to the pelvis. Of these, 74 patients were eligible. All patients were initially treated with total abdominal hysterectomy, bilateral salpingo-oophorectomy, and staging laparotomy, with radiation and chemotherapy left to the discretion of the treating physician and patient. Fifteen pathologic variables were examined to identify differences in tumor behavior. Of the 74 patients, 23 (31%) had microscopic spread of tumor in the pelvis or abdomen. Sixty-four (86%) patients had endometrioid carcinomas in both the endometrium and the ovary, and endometriosis was found in the ovary of 23 (31%) patients. There was concordance between the histologic grade of the tumor in the ovary and the uterus in 51 (69%) patients. The estimated probability of recurrence 5 years following staging surgery is 15.1%. The presence of metastasis discriminated 2 groups of patients that experienced different probabilities of recurrence within 5 years: 10.0% for those with tumors confined to the uterus and ovary, and 27.1% for those with metastasis. The histologic grades of ovarian and uterine tumors also distinguished groups of patients with different probabilities of recurrence at 5 years: 8.0% for those patients with no more than grade 1 disease at either site and 22.4% for those with a higher grade in either the ovary or the endometrium. The estimated overall probability of surviving 5 years is 85.9% and that of surviving 10 years is 80.3%. Zaino et al concluded that the prognosis for women with simultaneously detected carcinomas in the uterus and ovary with gross disease confined to the pelvis is surprisingly good, particularly for those with disease microscopically limited to the uterus and ovary or of low histologic grade.
Comment by David M. Gershenson, MD
This study is a simple yet important step toward understanding the pathogenesis and biologic behavior of synchronous tumors of the endometrium and ovary. The coexistence of these 2 tumors is uncommon and occurs in approximately 5% of women with endometrial cancer and 10% of women with ovarian cancer. Prior to publication of this study, the literature has consisted of small, usually retrospective series. In addition, although histologic criteria have been proposed for distinguishing this entity of synchronous tumors, they have not been validated in any large study. Furthermore, several investigators have attempted to define the molecular signatures of synchronous tumors of the endometrium and ovary through molecular analysis in order to distinguish them from tumors metastatic from endometrium to ovary or vice versa. However, such reports have been hampered by disagreements in methodology and interpretation of results. Ultimately, this entity will be defined by its molecular profile. In my view, this report elucidates the excellent clinical course of patients with synchronous endometrioid tumors of the uterus and ovary. Importantly, the obstetrician-gynecologist should be aware of the existence of this uncommon entity and understand that prognosis is not worsened but actually improved by having 2 cancers rather than 1.
Dr. Gershenson is Professor and Deputy Chairman, Department of Gynecolgy, M.D. Anderson Cancer Center, Houston, TX.