Uterine clear-cell carcinoma

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]

Uterine clear-cell carcinoma
SpecialtyGynecology, oncology

Diagnosis

The lesion is found in patients who present typically with abnormal or postmenopausal bleeding or discharge. 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.

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

Uterine clear-cell carcinoma is staged like other forms of endometrial carcinoma at time of surgery using the International Federation of Gynecology and Obstetrics (FIGO) cancer staging system 2009.[4]

IA Tumor confined to the uterus, no or < 1⁄2 myometrial invasion

IB Tumor confined to the uterus, > 1⁄2 myometrial invasion

II Cervical stromal invasion, but not beyond uterus

IIIA Tumor invades serosa or adnexa

IIIB Vaginal and/or parametrial involvement

IIIC1 Pelvic node involvement

IIIC2 Para-aortic involvement

IVA Tumor invasion bladder and/or bowel mucosa

IVB Distant metastases including abdominal metastases and/or inguinal lymph nodes

References
  1. Gründker C, Günthert AR, Emons G (2008). "Hormonal heterogeneity of endometrial cancer". Adv Exp Med Biol. Advances in Experimental Medicine and Biology. 630: 166–188. doi:10.1007/978-0-387-78818-0_11. ISBN 978-0-387-78817-3. PMID 18637491.
  2. 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 & J K Chan (Mar 2006). "Uterine papillary serous and clear cell carcinomas predict for poorer survival compared to grade 3 endometrioid corpus cancers". British Journal of Cancer. 94 (5): 642–6. doi:10.1038/sj.bjc.6603012. PMC 2361201. PMID 16495918.
  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. 13 (1): 23–30. PMID 18404782.
  4. International Journal of Gynecology and Obstetrics 105 (2009) 103–104 Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium
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