What is metastatic endometrial cancer (stage 4 endometrial cancer)?
Any cancer has the ability to spread regionally, to nearby lymph nodes, tissues, or organs or to distant parts of the body. When this happens, it is called a metastatic cancer. Sometimes, it is also called stage IV (four) cancer. The process by which cancer cells spread to other parts of the body is called metastasis.
When observed under a microscope, endometrial metastatic cancer cells have features similar to that of the primary cancer where it originated from and not like the cells of the place where the endometrial cancer has metastasized to. This helps the doctors know whether it is a cancer of some different location or a metastatic cancer.
Endometrial cancer metastasis sites: Where does endometrial cancer metastasize to generally?
Endometrial cancer very often metastasizes to the ovaries and fallopian tubes when the cancer is located in the upper part of the uterus, and the cervix when the cancer is in the lower part of the uterus.
Usually, endometrial cancer first spreads into the myometrium and the serosa, and then to other pelvic organs. It can metastasize to even further locations such as the lungs, brain, bone etc by the blood. According to an estimate, in about 20% cases, endometrial cancer metastasizes to the lungs. No other gynecologic cancer or neoplasm metastasizes this much as often.
Stage 4 or metastatic endometrial cancers are generally grouped into two categories:
Stage IVA: These are endometrial cancers that have grown inside the bladder or bowel
Stage IVB: These are endometrial cancers that have spread to lymph nodes outside the pelvis or para-aortic area or to the liver, lungs, omentum, brain or other nearby or distant organs.
How often does an endometrial cancer metastasize?
The majority of patients have their cancer confined to the uterus and have an excellent overall prognosis. However, some patients have advanced primary cancer or recurrences after the primary treatment of their endometrial cancer.
Can stage 4 endometrial cancer be cured?
In most cases of metastatic endometrial cancer (or metastatic endometrial carcinoma), the cancer has spread too far for it all to be removed with surgery or any other way. It is not possible to cure it. But there are ways to help ease the symptoms.
Treatment choices for metastatic (stage 4) endometrial cancer
The management of metastatic endometrial cancer is variable, and it depends on many factors such as comorbidities, tumor grade, performance status, and past treatments etc.
Such a cancer or adenocarcinoma cannot be treated with surgery alone as it has spread too far into the distant locations. A hysterectomy and removal of both fallopian tubes and ovaries may though be done to prevent bleeding. Sometimes, doctors use radiation therapy as well.
Hormonal therapy and cytotoxic chemotherapy have been used traditionally in the treatment of metastatic endometrial cancer. Multiple potential targeted therapies are also being used and evaluated for the treatment of metastatic endometrial cancer. Drugs used for hormone therapy are such as progestins and tamoxifen. Aromatase inhibitors may also be useful and are being researched.
Side effects are generally minimal for hormone therapy, but the response rate is usually low (about 10%).
Combinations of chemotherapy drugs may be helpful in some cases of advanced metastatic endometrial cancer. Women with stage IV endometrial cancer can consider taking part in clinical trials for evolving and new treatment options that are being investigated.
Metastatic endometrial cancer survival rates and life expectancy, metastatic endometrial cancer prognosis
While several treatment options are now available to treat patients with metastatic endometrial cancer, the overall prognosis is still poor.
The 5-year survival rate for women with stage IVA metastatic endometrial cancer is 17%
The 5-year survival rate for women with stage IVB metastatic endometrial cancer is 15%