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Standards of Care Evolving for Uncommon Uterine Cancer

More clinical trials needed to guide management of uterine papillary serous carcinoma

TUESDAY, Oct. 13 (HealthDay News) -- Uterine papillary serous carcinoma (UPSC), the less common form of endometrial cancer, causes a disproportionate number of deaths, and more clinical trials are needed to develop evidence-based management strategies, according to a literature review in the October issue of Gynecologic Oncology.

David M. Boruta II, M.D., of Massachusetts General Hospital in Boston, and colleagues reviewed the medical literature for studies completed between 1966 and 2009 that evaluated populations of women with UPSC. The researchers described the differences between UPSC and the more common endometrioid carcinoma, offering recommendations for UPSC management.

The authors suggest that UPSC is distinct from endometrioid carcinoma and tends to occur in older and thinner women, while endometrioid carcinoma occurs more in younger and overweight women. Metastatic disease is common in UPSC, both locally and distantly. The most common symptom in UPSC is post-menopausal vaginal bleeding; however, patients may present with abnormal cervical cytology, pelvic mass, or ascites. There have been few trials conducted and standards of care are still being developed.

"Women diagnosed with UPSC should undergo comprehensive surgical staging and an attempt at optimal cytoreduction. Platinum/taxane-based adjuvant chemotherapy should be considered in the treatment of both early- and advanced-stage patients. Careful long-term surveillance is indicated as many of these women will recur," Boruta and colleagues conclude. "Prospective clinical trials of women with UPSC are necessary in order to delineate the optimal therapy for women with newly diagnosed and recurrent disease."

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