Chapter 15 Cancer of the Corpus Uteri

Carol L. Kosary
Introduction
Cancer of the endometrium, the lining of the uterus, is the most common gynecologic malignancy. It is the 4th leading cancer in women (behind breast, lung and colorectal) and accounts for approximately 6% of all cancers in women (1). Uterine sarcomas are rare, comprising less than 8% of all uterine malignancies. These tumors arise primarily from two distinct tissues: 1) leiomyosarcoma from myometrial muscle and 2) mesodermal (Mullerian) and stromal sarcomas from endometrial epithelium. This analysis is based on data from 12 SEER geographic areas which collectively cover about 14% of the total US population. The areas are the States of Connecticut, Iowa, New Mexico, Utah, and Hawaii; the metropolitan areas of Detroit, Michigan; Atlanta, Georgia; San Francisco, San Jose, and Los Angeles, California; Seattle, Washington; and 10 counties in rural Georgia. Los Angeles contributed data for diagnosis years 1992 to 2001, all other areas for 1988-2001. Between 1988-2001, there were 57,769 cases of cancer of the corpus uteri diagnosed in SEER. Note: cancer of the corpus uteri does not include uterus, not otherwise specified (NOS). The following were excluded from the analysis: patients for whom cancer of the corpus uteri was not the first primary, cases identified through autopsy or death certificate only, persons of unknown race, alive cases with no survival time, patients less than 20 years old, cases of in situ cancers, cases without microscopic confirmation, and carcinoids. Unlike other chapters, sarcomas were included. After these exclusions, 48,642 adult cases remained for analysis (see Table 15.1).

Materials and Methods

The NCI contracts with medically-oriented, nonprofit institutions located in specific geographic areas to obtain data on all cancers diagnosed in residents of the SEER geographic areas. SEER collects data on all invasive and in situ cancers except basal cell and squamous cell carcinomas of the skin (of non-genital anatomic sites) and in situ carcinomas of the uterine cervix. SEER actively follows all previously diagnosed patients on an annual basis to obtain vital status allowing the calculation of observed and relative survival rates.

Table 15.1: Cancer of the Corpus Uteri: Number of Cases and Exclusions by Reason, 12 SEER Areas, 1988-2001 Number Selected/Remaining Number Excluded Reason for Exclusion/selection 57,769 50,570 50,453 50,144 50,083 50,073 48,877 48,661 48,642 0 7,199 117 309 61 10 1,196 216 19 Select 1988-2001 diagnosis (Los Angeles for 1992-2001 only) Select first primary only Exclude death certificate only or at autopsy Exclude unknown race Exclude alive with no survival time Exclude children (Ages 0-19) Exclude in situ cancers Exclude no or unknown microscopic confirmation Exclude carcinoids

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Results
Age and Race
Of the 48,642 cases, 63.5% of adults with cancer of the corpus uteri were diagnosed after age 60 years and older (Table 15.2). Over 50% were between the ages of 60-79 years. Eighty-seven percent were white. Little difference exists in age distribution for white and black women, but the age distribution for women of other races was younger. For all women, relative survival declines with age. In women 20-49 year of age, the 5-year relative survival rate is 90% compared to 87% in women 50-69 and 79% in women aged 70 and older. Survival is also lower for black women compared to white women in all age groups presented (Table 15.3). The largest survival difference was for age group 70+ where the 5-year relative survival rate was 49% for black females compared to 81% for white females.

Cancer of the Corpus Uteri

Staging
Uterine corpus cancer staging by the Federation Internationale de Gynecologie et dObstetrique (FIGO) and the American Joint Committee on Cancer (AJCC) are in the AJCC Manual for Staging of Cancer, 3rd edition (2):
Stage I tumor confined to the corpus uteri. Stage IA: tumor limited to endometrium Stage IB: tumor invades less than one half of the myometrium Stage IC: tumor invades one half or more of the myometrium Stage II tumor invades the cervix, but has not extended outside the uterus. Stage III tumor extends outside of the uterus but is confined to the true pelvis. Stage IV tumor involves the bladder or bowel mucosa or has metastasized to distant sites (including abdominal lymph nodes other than para-aortic, and/or inguinal lymph nodes; excludes metastasis to vagina, pelvic serosa, or adnexa).

Geographic Location
There is little variation in survival by geographic area. Five-year relative survival rates in the 12 SEER areas presented in this study ranged from 89% in Seattle to 81% in Detroit (Table 15.4).

Since the emphasis is on extension, a SEER modified version of stage was used in which positive lymph nodes went to N1 and Stage III but unknown lymph node involvement was ignored, i.e. treated like N0.

ADENOCARCINOMA
Stage
Table 15.6 and Figure 15.1 show the contrast across stage over time since diagnosis. In stages II-IV, the steepest declines in survival are observed within 1-3 years of diagnosis. Survival continues to decline throughout the 10 years observed for stage III.

Histology
Distribution by histology is presented in Table 15.5. Tumors classified as adenocarcinoma comprise over 90% of all cancers of the corpus uteri. Of these, the most common subclassification was adenocarcinoma, NOS, which accounted for slightly more than 53% of all adenocarcinomas registered. Endometrioid adenocarcinoma was the next most common adenocarcinoma, at 30% followed by papillary serous (3.5%), adenosquamous (2.9%), papillary (2.3%), squamous metaplasia (2.6%), mucinous (1.9%), and clear cell (1.6%). Sarcomas and Other Specified Types comprise 7.7% of the total. Of these 34% are Mullerian, 25% leiomyosarcoma, 19% carcinosarcoma and 16% endometrial stromal sarcoma. The 5-year relative survival rates vary greatly by histology from over 90% for adenocarcinoma, NOS, mucinous/mucin producing adenocarcinoma, and endometrioid adenocarcinoma to less than 50% for papillary serous adenocarcinoma, leiomyosarcoma, and Mullerian mixed tumor.

Age and Stage

Of the 44,059 cases of adenocarcinoma, enough information to establish stage at diagnosis was available for 42,589 (96.7%). Across all age groups, 70% or more of all cancers were diagnosed in Stage I. The percent of tumors limited to the endometrium or invading less than half of the myometrium (Stages IA and IB) declines from 64% in women age 20-49 to 46% in women 70 and over. Stage IV disease rises from 5% in women age 20-49 to 9% in women 70 and over. (Table 15.7). Across all age groups, a slight survival advantage is seen in Stage IA and IB disease compared to Stage IC. For all women, this translates to 99% 5-year survival for Stages IA & IB versus 92% for stage IC. Median survival time is over 10 years for all ages within Stage I, with the exception of women aged 70 and older diagnosed with Stage IC, where median survival time was found to be

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Cancer of the Corpus Uteri

Other Cases 3,357 39 251 747 938 768 480 134 Percent 100.0 1.2 7.5 22.3 27.9 22.9 14.3 4.0

Table 15.2: Cancer of the Corpus Uteri: Age (20+) and Race Distributions, 12 SEER Areas, 1988-2001 Total White Black Age Group (Years) Total 20-29 30-39 40-49 50-59 60-69 70-79 80+ Cases 48,642 218 1,542 5,254 10,740 13,816 11,972 5,100 Percent 100.0 0.4 3.2 10.8 22.1 28.4 24.6 10.5 Cases 42,220 154 1,145 4,198 9,226 12,032 10,792 4,673 Percent 100.0 0.4 2.7 9.9 21.9 28.5 25.6 11.1 Cases 3,065 25 146 309 576 1,016 700 293 Percent 100.0 0.8 4.8 10.1 18.8 33.1 22.8 9.6

Table 15.3: Cancer of the Corpus Uteri: Number of Cases, Median Survival Time (Months) and 5-Year Survival Rates (%) by Race and Age (20+), 12 SEER Areas, 1988-2001 Median Survival 5-Year Survival Rates (%) Time Race/Age All Races, 20+ White, 20+ Black, 20+ All Races, 20-49 White, 20-49 Black, 20-49 All Races, 50-69 White, 50-69 Black, 50-69 All Races, 70+ White, 70+ Black, 70+ Cases 48,642 42,220 3,065 7,014 5,497 480 24,556 21,258 1,592 17,072 15,465 993 (Months) > 120 > 120 72.1 > 120 > 120 > 120 > 120 > 120 99.8 89.0 92.2 28.4 Observed 75.1 76.3 53.2 88.7 90.0 76.5 82.1 83.9 57.4 59.8 61.3 35.6 Expected 88.6 88.2 86.1 98.9 98.9 97.8 94.3 94.4 90.6 76.1 76.0 73.3 Relative 84.7 86.4 61.8 89.7 91.0 78.1 87.0 88.9 63.4 78.6 80.6 48.6

Table 15.4: Cancer of the Corpus Uteri: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates (%) by SEER Geographic Area, Ages 20+, 12 SEER Areas, 1988-2001 Relative Survival Rate (%) SEER Geographic Area Total Atlanta and Rural Georgia Atlanta (Metropolitan) - 1988+ Rural Georgia - 1988+ California Los Angeles - 1992+ Greater Bay Area San Francisco-Oakland SMSA - 1988+ San Jose-Monterey - 1988+ Connecticut - 1988+ Detroit (Metropolitan) - 1988+ Hawaii - 1988+ Iowa - 1988+ New Mexico - 1988+ Seattle (Puget Sound) - 1988+ Utah - 1988+ 7,978 8,591 5,882 2,709 6,198 6,451 1,585 5,266 1,837 5,860 2,230 16.4 17.7 12.1 5.6 12.7 13.3 3.3 10.8 3.8 12.0 4.6 92.1 93.8 93.8 93.8 94.6 91.8 93.9 93.8 94.4 95.4 94.0 87.2 89.7 89.6 90.1 90.8 86.7 89.7 90.2 91.0 92.6 90.4 84.6 87.6 87.5 87.7 88.7 83.6 87.4 87.7 87.8 90.6 88.0 81.7 85.6 85.9 85.0 86.5 81.0 84.1 85.7 85.4 89.2 85.1 80.4 83.8 83.6 84.3 85.2 79.2 81.5 84.6 82.8 88.1 83.2 79.0 83.6 83.2 84.0 84.2 78.4 81.0 84.1 82.6 88.1 82.1 Cases 48,642 2,646 2,508 138 Percent 100.0 5.4 5.2 0.3 1-Year 93.5 93.1 93.0 95.0 2-Year 89.5 88.3 88.1 91.1 3-Year 87.0 85.4 85.5 84.1 5-Year 84.7 82.9 82.9 81.5 8-Year 83.1 80.1 80.3 76.8 10-Year 82.6 79.6 79.8 72.1

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Cancer of the Corpus Uteri

Table 15.5: Cancer of the Corpus Uteri: Number and Distribution of Cases and 5-Year Relative Survival Rate (%) by Histology, Ages 20+, 12 SEER Areas, 1988-2001 5-Year Histology ICD-O Code Cases Percent RSR (%) All Values Epidermoid Adenocarcinoma Adenocarcinoma, NOS* Papillary Clear Cell Mucinous & Mucin Producing Adenosquamous Endometrioid Papillary Serous All Other Adenocarcinoma 8000-9989 8051-8130 8050,8140-8147,8160-8162,8180-8221,8250-8506,85208550,8560,8570-8573,8940-8941 8140 80508260 8310 48,642 132 44,059 23,489 1,035 704 1,151 824 1,256 13,258 1,555 100.0 0.3 90.6 48.3 2.1 1.4 2.4 1.7 2.6 27.3 3.2 84.7 61.1 87.9 90.8 70.3 64.8 93.8 95.0 74.0 91.2 44.7

With Squamous Metaplasia 8570 8480-8481 8560 8380 8460 8141-8147,8160-8162,8180-8221,8250-8259,8261-8309,83118379,8381-8459,8461-8479,8482-8506,8520-8550,85718573,8940-8941 8030-8045,8150-8155,8170-8171,8230-8248,8510-8512,85618562,8580-8671 8010-8022 8680-8713,8720-8790,8800-8920,8930-8933,8950-8982,89908991,9000-9030,9040-9055,9060-9110,9120-9134,91419340,9350-9364,9380-9512,9530-9581 8890-8897 8933,8980-8981 8930 8950-8951 8680-8713,8720-8790,8800-8889,8898-8920,89318932,8935,8952-8979,8982,8990-8991,9000-9030,90409055,9060-9110,9120-9134,9141-9340,9350-9364,9380-9512,9530-9581 8000-8004
~ * Statistic not displayed due to less than 25 cases. NOS: Not Otherwise Specified

787 24 608

1.6 0.0 1.2

68.5 ~ 58.4

Other Specified Carcinomas Carcinoma, NOS* Sarcomas and Other Specified Types Leiomyosarcoma Carcinosarcoma Endometrial Stromal Mullerian All Other

3,742 939 706 610 1,264

7.7 1.9 1.5 1.3 2.6

53.3 48.2 53.7 74.6 45.3

230 70

0.5 0.1

53.9 55.1

Unspecified

Table 15.6: Adenocarcinoma of the Corpus Uteri: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates (%) by AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001 Relative Survival Rate(%) AJCC Stage Total Stage I IA IB IC I NOS* Stage II Stage III Stage IV Unknown/Unstaged
*

Cases 44,059 33,179 9,528 15,084 4,142 4,425 3,475 2,651 3,284 1,470

Percent 100.0 75.3 21.6 34.2 9.4 10.0 7.9 6.0 7.5 3.3

1-Year 95.2 99.7 99.9 100.0 99.1 97.8 94.8 87.5 61.5 83.5

2-Year 92.1 99.1 99.8 100.0 97.2 95.8 89.7 75.8 44.4 72.5

3-Year 89.9 98.3 99.5 99.7 95.0 93.8 85.1 68.2 35.8 66.8

5-Year 87.9 97.4 99.3 99.2 91.9 92.1 80.2 59.6 28.6 63.5

8-Year 86.4 96.3 99.0 98.3 88.4 90.5 77.2 53.4 25.3 60.3

10-Year 86.0 95.7 99.0 97.5 86.2 90.2 76.5 50.5 25.3 59.6

NOS: Not Otherwise Specified

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Table 15.7: Adenocarcinoma of the Corpus Uteri: Distribution by AJCC Stage (SEER modified 3rd edition) and Age (20+), 12 SEER Areas, 1988-2001 Age (Years) Total AJCC Stage Total Stage I IA IB IC I NOS* Stage II Stage III Stage IV Unknown/Unstaged Cases 44,059 33,179 9,528 15,084 4,142 4,425 3,475 2,651 3,284 1,470
* NOS: Not Otherwise Specified

20-49 Percent 100.0 75.3 21.6 34.2 9.4 10.0 7.9 6.0 7.5 3.3 Cases 5,931 4,604 2,040 1,723 193 648 481 352 317 177 Percent 100.0 77.6 34.4 29.1 3.3 10.9 8.1 5.9 5.3 3.0 Cases

50-69 Percent 100.0 78.2 23.1 37.6 7.9 9.6 7.0 5.5 6.8 2.4 Cases 22,606 17,679 5,224 8,500 1,789 2,166 1,592 1,250 1,539 546

70+ Percent 100.0 70.2 14.6 31.3 13.9 10.4 9.0 6.8 9.2 4.8 15,522 10,896 2,264 4,861 2,160 1,611 1,402 1,049 1,428 747

Table 15.8: Adenocarcinoma of the Corpus Uteri: Number of Cases and 5-Year Relative Survival Rates (RSR) (%) by AJCC Stage (SEER modified 3rd edition) and Age (20+), 12 SEER Areas, 1988-2001 Total 20-49 50-69 70+ 5-Year RSR (%) 87.9 97.4 99.3 99.2 91.9 92.1 80.2 59.6 28.6 63.5 Median Survival Time (Months) > 120 > 120 > 120 > 120 > 120 > 120 > 120 66.6 17.8 62.8 5-Year RSR (%) 93.2 98.2 98.9 98.1 94.8 97.4 91.1 76.0 46.0 83.3 Median Survival Time (Months) > 120 > 120 > 120 > 120 > 120 > 120 > 120 > 120 42.4 > 120 5-Year RSR (%) 89.7 97.2 99.4 98.2 90.4 93.8 84.1 65.3 31.9 77.3 Median Survival Time (Months) > 120 > 120 > 120 > 120 > 120 > 120 > 120 102.3 21.2 > 120 5-Year RSR (%) 82.5 97.8 99.3 100.0 93.3 86.6 70.3 45.5 19.3 42.2 Median Survival Time (Months) 96.5 > 120 > 120 > 120 107.4 102.4 64.7 32.9 12.6 23.3

AJCC Stage Total Stage I IA IB IC I NOS Stage II Stage III Stage IV Unknown/ Unstaged

Cases 44,059 33,179 9,528 15,084 4,142 4,425 3,475 2,651 3,284 1,470

Cases 5,931 4,604 2,040 1,723 193 648 481 352 317 177

Cases 22,606 17,679 5,224 8,500 1,789 2,166 1,592 1,250 1,539 546

Cases 15,522 10,896 2,264 4,861 2,160 1,611 1,402 1,049 1,428 747

Figure 15.1: Adenocarcinoma of the Corpus Uteri: Relative Survival Rate (%) by AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001
100

Figure 15.2: Adenocarcinoma of the Corpus Uteri: 5-Year Relative Survival Rate (%) by AJCC Stage (SEER modified 3rd edition) and Age Group (20+), 12 SEER Areas, 1988-2001
100

Relativ ve Survival l Rate (%) )

90 80 70 60 50 40 30 20 10 0 0 12 24 36 48 60 72 84 96 108 120

IB IC II III IV

Relative S R Survival Rate (%)

IA

90 80 70 60 50 40 30 20 10 0 IA IB IC II III IV AJCC Stage 20-49 50-69 70+

Months after diagnosis

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107 months. A survival differential across age exists for Stages II-IV. Women ages 20-49 diagnosed with Stage II disease experience a 5-year relative survival rate of 91%. This falls to 84% for women age 50-69 and 70% for women ages 70 and older. For Stage III, survival is 76% in women 20-49, 65% in those 50-69 and 45% for those aged 70 and over. For Stage IV, survival is 46% in women under 50, 32% in those 50-69 and 19% for those aged 70 and over (Table 15.8, Figure 15.2).

Cancer of the Corpus Uteri

Subtype and Stage
Survival by subtype and stage is presented in Table 15.9 and Figure 15.3. A survival disadvantage is seen in tumors of the papillary serous subtype across all stages. These tumors are histologically similar to those found in the ovary. Similar but smaller differentials are observed for clear cell and papillary subtypes. Adenosquamous may have a slight survival disadvantage in Stage I. This may be due to more of these tumors being diagnosed in Stage IC and fewer in Stage IA (Table 15.10). Tumors exhibiting squamous metaplasia exhibit higher survival, particularly in stages III

Figure 15.3: Adenocarcinoma of the Corpus Uteri: 5-Year Relative Survival Rate (%) by Histology and AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001

Figure 15.4: Adenocarcinoma of the Corpus Uteri: 5-Year Relative Survival Rate (%) by Grade and AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001

Relat tive Surv vival Rat te (%)

Stage I

Stage II Stage III AJCC Stage

Stage IV

Relativ ve Surviv val Rat e e(%)

100 90 80 70 60 50 40 30 20 10 0

100 90 80 70 60 50 40 30 20 10 0 IA IB IC II III IV AJCC Stage g

Grade I Grade II Grade III Grade IV

Adenocarcinoma, NOS Clear Cell Mucinous & Mucin Producing Endometroid

Papillary With Squamous Metaplasia Adenosquamous Papillary Serous

Table 15.9: Adenocarcinoma of the Corpus Uteri: Number of Cases and 5-Year Relative Survival Rates (%) by Histology and AJCC Stage (SEER modified 3rd edition) , Ages 20+, 12 SEER Areas, 1988-2001 AJCC Stage Total I II III IV Unknown/ Unstaged

Histology Total Adenocarcinoma, NOS* Papillary Clear Cell With Squamous Metaplasia Mucinous & Mucin Producing Adenosquamous Endometrioid Papillary Serous All Other Adenocarcinoma
~ *

5-Year 5-Year 5-Year 5-Year 5-Year 5-Year RSR RSR RSR RSR RSR RSR Cases (%) Cases (%) Cases (%) Cases (%) Cases (%) Cases (%) 44,059 23,489 1,035 704 1,151 824 1,256 13,258 1,555 787 87.9 33,179 90.8 18,775 70.3 64.8 93.8 95.0 74.0 44.7 68.5 634 338 952 621 730 531 449 97.4 98.0 91.0 88.4 97.2 99.9 89.9 98.4 73.9 92.5 3,475 1,602 107 90 82 53 161 1,149 163 68 80.2 81.3 56.8 67.3 84.6 95.7 78.4 85.7 55.8 46.7 2,651 965 80 94 47 63 136 904 258 104 59.6 59.8 49.4 47.8 84.6 83.9 57.0 66.9 33.3 42.5 3,284 1,272 162 139 46 60 191 727 542 145 28.6 30.1 17.0 17.9 51.7 43.3 24.8 36.8 18.3 14.5 1,470 875 52 43 24 27 38 329 61 21 63.5 66.6 23.4 54.1 ~ 73.1 55.1 65.4 34.4 ~

91.2 10,149

Statistic not displayed due to less than 25 cases. NOS: Not Otherwise Specified

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Table 15.10: Stage I Adenocarcinoma of the Corpus Uteri: Distribution by Histology and Detailed AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001 AJCC Stage Total Stage I Histology Total Adenocarcinoma, NOS* Papillary Clear Cell With Squamous Metaplasia Mucinous & Mucin Producing Adenosquamous Endometrioid Papillary Serous All Other Adenocarcinoma
*

IA Cases 9,528 5,327 180 107 277 199 125 2,944 193 176 Row Percent 28.7 28.4 28.4 31.7 29.1 32.0 17.1 29.0 36.3 39.2 Cases

IB Row Percent 45.5 44.5 39.3 41.4 48.4 43.2 47.3 48.2 39.7 37.9 Cases

IC Row Percent 12.5 11.9 12.1 12.4 10.6 11.8 21.0 13.3 13.0 7.8

I NOS Cases 4,425 2,857 128 49 113 81 107 964 58 68 Row Percent 13.3 15.2 20.2 14.5 11.9 13.0 14.7 9.5 10.9 15.1

Cases 33,179 18,775 634 338 952 621 730 10,149 531 449

Row Percent 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

15,084 8,352 249 140 461 268 345 4,888 211 170

4,142 2,239 77 42 101 73 153 1,353 69 35

NOS: Not Otherwise Specified

and IV. Clear cell and papillary types show lower survival in stages II-IV.

Conditional Survival
Five year relative survival rates, conditioned on years since diagnosis, are presented in Table 15.12 and Figure 15.5. For stages IC-IV, the probability of surviving the next 5 years increases as time since diagnosis increases. This is most marked for the stage IV cases. Five year survival from time of diagnosis is 29%. For those individuals who survive 1 year post diagnosis, 5-year survival increases to 43%. This increases to 86% for those individuals who survived 5 years.

Stage and Grade

Five-year relative survival rates for adenocarcinoma are shown by tumor grade in Table 15.11 and Figure 15.4. Within stage, 5-year relative survival rates declined as grade increases with the exception of poorly differentiated and anaplastic Stage IV tumors.

Table 15.11: Adenocarcinoma of the Corpus Uteri: Number of Cases and 5-Year Relative Survival Rates (%) by AJCC Stage (SEER modified 3rd edition) and Grade, Ages 20+, 12 SEER Areas, 1988-2001 Grade Total 5-Year RSR (%) 87.9 97.4 99.3 99.2 91.9 92.1 80.2 59.6 28.6 63.5 Well Differentiated 5-Year RSR (%) 99.2 100.0 99.9 100.0 99.4 98.4 93.1 82.7 59.9 79.4 Moderately Differentiated 5-Year RSR (%) 90.8 97.2 99.2 98.7 95.3 89.9 84.7 68.0 45.1 63.1 Poorly Differentiated 5-Year RSR (%) 64.9 86.6 90.9 92.5 77.0 75.3 66.7 48.3 16.9 36.3 Anaplastic 5-Year RSR (%) 54.8 79.7 83.3 88.9 63.6 60.9 51.3 46.4 19.9 38.3 Unknown 5-Year RSR (%) 72.9 93.0 95.3 95.7 88.0 85.2 68.3 45.0 21.1 62.8

AJCC Stage Total Stage I IA IB IC I NOS* Stage II Stage III Stage IV Unknown/Unstaged
*

Cases 44,059 33,179 9,528 15,084 4,142 4,425 3,475 2,651 3,284 1,470

Cases 17,429 15,472 5,517 6,631 1,161 2,163 847 370 269 471

Cases 15,002 11,492 2,599 5,741 1,813 1,339 1,399 898 801 412

Cases 7,544 4,061 741 1,895 899 526 835 970 1,426 252

Cases 1,294 557 114 261 124 58 150 210 323 54

Cases 2,790 1,597 557 556 145 339 244 203 465 281

NOS: Not Otherwise Specified

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SARCOMA AND OTHER SPECIFIED TYPES
Subtype and Stage
Of the 3,742 cases of sarcoma and other specified types, enough information to establish stage at diagnosis was available for 3,580 (96%). Fifty six percent were diagnosed in Stage I, while 22% were Stage IV (Table 15.13). Survival by stage for sarcomas overall is presented in Figure 15.6. Survival by subtype and stage is presented in Table 15.14. Despite some data sparseness in Stage II, it is observed that endometrial stromal tumors experience a better survival across stage than do either tumors categorized as

Cancer of the Corpus Uteri

leiomyosarcoma, carcinosarcoma, or Mullerian, which had similar survival rates.

Stage and Grade

Despite data sparseness in well differentiated, within stage, 5-year relative survival declines as grade increases (Table 15.15).

Conditional Survival
Five year relative survival, conditioned on years since diagnosis, is presented in Table 15.16 and Figure 15.7 for sarcomas and other specific types. For all stages, the probability of surviving the next 5 years increased as time since
Figure 15.6: Sarcoma and Other Specified Types of Cancer of the Corpus Uteri: Relative Survival Rates (%) by AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 19882001
100

Figure 15.5: Adenocarcinoma of the Corpus Uteri: 5-Year Relative Survival Rate (%), Conditioned on Years Since Diagnosis, by AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001
100 90 80 70 60 50 40 30 20 10 0 IA
0 Years

IA IB IC II III IV

Relative Surv vival Rat te (%)

Re elative Su urvival Ra ate (%)

90 80 70 60 50 40 30 20 10

IB
1 Year

IC II AJCC St Stage
2 Years 3 Years

III
4 Years

IV
5 Years

0 0 12 24 36 48 60 72 84 96 108 120 Months after diagnosis

Table 15.12: Adenocarcinoma of the Corpus Uteri: 5-Year Relative Survival Rates (%), Conditioned on Years Since Diagnosis, by AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001 5-Year Relative Survival Rate (%) Years Since Diagnosis AJCC Stage Total Stage I IA IB IC I NOS* Stage II Stage III Stage IV Unknown/Unstaged
*

0 87.9 97.4 99.3 99.2 91.9 92.1 80.2 59.6 28.6 63.5
NOS: Not Otherwise Specified

1 91.2 97.3 99.3 98.6 92.0 93.2 81.6 64.2 43.2 71.5

2 93.9 97.9 99.6 99.0 92.9 94.6 85.0 71.0 57.8 79.4

3 95.5 98.1 99.6 99.0 93.3 95.7 89.4 76.7 68.1 84.2

4 96.9 98.7 99.8 99.3 94.4 97.1 91.1 80.1 78.6 86.0

5 97.4 98.7 99.9 99.1 94.3 97.2 93.6 83.0 86.0 87.5

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Table 15.13: Sarcoma & Other Specified Types of Corpus Uterine Cancer: Number and Distribution of Cases and 1-, 2-, 3-, 5-, 8-, & 10-Year Relative Survival Rates (%) by AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001 Relative Survival Rate (%) 1-Year AJCC Stage Total Stage I IA IB IC I NOS Stage II Stage III Stage IV Unknown/Unstaged
*

2-Year Percent 64.4 81.4 90.0 78.2 75.9 81.3 56.4 52.2 32.0 49.2

3-Year Percent 58.4 76.3 86.4 73.7 69.4 75.4 49.7 45.2 23.9 44.8

5-Year Percent 53.3 70.8 84.3 68.2 62.1 68.7 43.6 38.8 19.8 39.7

8-Year Percent 50.0 66.2 81.2 64.9 59.0 61.7 39.8 34.5 19.6 35.9

10-Year Percent 49.1 64.5 76.0 63.7 56.7 61.0 39.0 33.4 19.6 34.6

Cases 3,742 2,081 397 558 280 846 277 394 828 162

Percent 100.0 55.6 10.6 14.9 7.5 22.6 7.4 10.5 22.1 4.3

Percent 78.4 92.2 94.4 91.1 90.7 92.4 81.0 69.7 50.1 62.0

NOS: Not Otherwise Specified

Table 15.14: Sarcoma & Other Specified Types of Corpus Uterine Cancer: Number of Cases and 5-Year Relative Survival Rates (%) by Histology and AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001 AJCC Stage Total 5-Year Relative Survival Cases Rate(%) 3,742 939 706 610 1,264 223
~

II

III

IV

Unknown/ Unstaged

Histology Total Leiomyosarcoma Carcinosarcoma Endometrial Stromal Mullerian All Other

Cases 2,081 623 401 372 570 115

5-Year 5-Year 5-Year 5-Year 5-Year Relative Relative Relative Relative Relative Survival Survival Survival Survival Survival Rate(%) Cases Rate(%) Cases Rate(%) Cases Rate(%) Cases Rate(%) 70.8 60.0 73.7 89.8 66.7 74.3 277 28 62 27 147 13 43.6 35.1 43.3 40.0 45.7 ~ 394 64 97 85 132 16 38.8 27.7 26.2 64.3 34.8 ~ 828 185 122 106 353 62 19.8 14.9 13.6 37.0 18.2 21.4 162 39 24 20 62 17 39.7 51.6 ~ ~ 19.4 ~

53.3 48.2 53.7 74.6 45.3 53.6

Statistic not displayed due to less than 25 cases.

Table 15.15: Sarcoma & Other Specified Types of Corpus Uterine Cancer: Number of Cases and 5-Year Relative Survival Rates (%) by AJCC Stage (SEER modified 3rd edition) and Grade, Ages 20+, 12 SEER Areas, 1988-2001 Grade Total 5-Year Relative Survival Rate(%) 53.3 70.8 84.3 68.2 62.1 68.7 43.6 38.8 19.8 39.7 Well Differentiated 5-Year Relative Survival Rate(%) 86.1 92.6 96.2 88.0 ~ 90.4 ~ ~ ~ ~ Moderately Differentiated 5-Year Relative Survival Rate(%) 79.2 84.8 88.8 84.0 84.6 83.1 78.6 68.6 47.9 ~ Poorly/ Undifferentiated 5-Year Relative Survival Rate(%) 35.8 54.8 71.6 58.6 47.6 49.9 36.0 28.2 13.2 9.1 Unknown 5-Year Relative Survival Rate(%) 52.8 69.8 82.8 66.7 63.3 64.4 39.2 35.8 20.7 44.3

AJCC Stage Total Stage I IA IB IC I NOS* Stage II Stage III Stage IV Unknown/Unstaged
~ *

Cases 3,742 2,081 397 558 280 846 277 394 828 162

Cases 218 167 37 32 10 88 8 14 20 9

Cases 593 435 80 93 48 214 26 59 58 15

Cases 1,351 603 60 215 118 210 124 177 407 40

Cases 1,580 876 220 218 104 334 119 144 343 98

Statistic not displayed due to less than 25 cases. NOS: Not Otherwise Specified

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Chapter 15

Cancer of the Corpus Uteri

Table 15.16: Sarcoma & Other Specified Types of Corpus Uterine Cancer: 5-Year Relative Survival Rates (%), Conditioned on Years Since Diagnosis, by AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001 5-Year Relative Survival Rate(%) Years Since Diagnosis AJCC Stage Total Stage I IA IB IC I NOS* Stage II Stage III Stage IV Unknown/Unstaged
*

0 53.3 70.8 84.3 68.2 62.1 68.7 43.6 38.8 19.8 39.7
NOS: Not Otherwise Specified

1 64.8 73.8 87.7 72.2 64.9 70.6 53.1 51.3 38.3 56.5

2 77.8 82.6 91.3 83.2 77.2 78.4 71.1 66.7 59.6 67.1

3 83.2 85.6 93.3 86.3 84.1 81.1 76.1 72.8 80.8 69.9

4 87.2 88.2 91.6 88.3 89.5 84.9 83.1 77.7 91.4 73.7

5 89.5 90.0 90.3 91.0 90.1 88.2 86.5 82.9 95.4 74.5

Figure 15.7: Sarcoma and Other Specified Types of Cancer of the Corpus Uteri: 5-Year Relative Survival Rate (%), Conditioned on Years Since Diagnosis, by AJCC Stage (SEER modified 3rd edition), Ages 20+, 12 SEER Areas, 1988-2001
100 90

older women is compounded by advanced stage. In later stages, particularly stages III and IV, survival declines rapidly over time since diagnosis. Overall, all histologies in stage I had a favorable 5-year survival. The papillary serous histology had the worst survival across all stages, while papillary metaplasia had the highest survival in stages II-IV. In the group of sarcoma histologies, endometrial stromal sarcomas had a better survival across stage than other sarcomas. Across all stages, survival declined with advanced stage of disease, with the exception of poorly differentiated and anaplastic tumors where there is little difference in survival for adenocarcinomas.

Rel lative Su urvival R Rate (%)

80 70 60 50 40 30 20 10 0 IA
0 Years

IB
1 Year

IC II AJCC Stage g
2 Years 3 Years

III
4 Years

IV
5 Years

References
1. American Cancer Society. Cancer Facts and Figures 2006. Atlanta: American Cancer Society, 2006. 2. Beahrs, OH, Henson DE, Hutter RVP, Myers MH (eds). AJCC Cancer Staging Manual, Third edition. American Joint Committee on Cancer. Philadelphia: Lippincott, 1988.

diagnosis increased. This is most marked for the stage IV cases. Five year survival from time of diagnosis was 20%. For those individuals who survived 1 year post diagnosis, 5-year survival increased to 38%. This increased to 91% for those individuals who survived 4 years.

Discussion
Survival is lower for blacks compared to whites regardless of age, and is most pronounced in women over 70 years of age. The majority of corpus uteri tumors are adenocarcinomas. Of these, more than 70% are diagnosed in stage I and have a median survival greater than 10 years for women of all age groups, except in women over 70 years of age with stage IC where the median survival is slightly less than 10 years. There exists a differential in survival by age and across stage of disease II-IV. The poorer survival in

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