People with uterine cancer may have questions about their prognosis and survival. Prognosis and survival depend on many factors. Only a doctor familiar with a person's medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis.
A prognosis is the doctor's best estimate of how cancer will affect a person, and how it will respond to treatment. A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together and they both play a part in deciding on a treatment plan and a prognosis.
The following are prognostic and predictive factors for uterine cancer.
Grade
Grade (histologic differentiation) is one of the more important prognostic factors. Grade 1 or 2 tumours have a better prognosis and are less likely to recur than Grade 3 tumours.
Myometrial invasion
How far the tumour invades into the myometrium (middle layer of the uterine wall) is a consistent indicator of cancer recurrence and survival. The deeper the tumour invades, the poorer the prognosis. The degree of myometrial invasion is often classified as:
- none – localized to the endometrium
- superficial – less than 50%
- deep – greater than 50%
Myometrial invasion is closely linked to the grade of the tumour. A higher grade tumour has a greater chance of invading the myometrium. These 2 factors are combined to estimate survival.
Stage
Stage of the cancer is an important prognostic factor. Stage I cancers have the most favourable prognosis. Cancers have a less favourable prognosis if they have spread beyond the uterus, including the following sites:
- lymph nodes
- Lymph node spread in early stage uterine cancer is related to the grade of the tumour.
- cervix
- structures in the pelvis and abdomen (also known as extrauterine disease)
Type of tumour
The type of uterine tumour is an important prognostic factor. Endometrial carcinomas have a more favourable prognosis than uterine sarcomas. Some subtypes within these groups have more favourable prognoses than others. For example, endometrioid carcinomas have a more favourable prognosis than serous adenocarcinomas. Also, endometrial stromal sarcomas have a more favourable prognosis than leiomyosarcomas.
Peritoneal cytology
The presence of cancer cells in the fluid in the abdominal cavity (peritoneal fluid) is an important prognostic factor. It often indicates that the cancer has spread outside the uterus. This prognostic factor is often associated with other factors, such as how deep the cancer invades into the myometrium and if the cancer has spread to lymph nodes. Positive peritoneal cytology often indicates a more aggressive cancer and a less favourable prognosis.
Hormone receptors
The presence of progesterone receptors on the tumour cells may be associated with a cancer that is less aggressive. Positive progesterone receptors are associated with a better response to hormonal therapy, regardless of the grade of the tumour. This helps doctors to determine the prognosis for women who have cancer that has spread beyond the uterus. Estrogen receptors have no prognostic importance in uterine cancer.
Age
Younger women tend to have a better prognosis overall than post-menopausal women, even though there may be some delay in diagnosis if the symptom of bleeding is initially overlooked. Younger women often have lower grade tumours that are found at an earlier stage, with less myometrial invasion. Women older than 70 or 80 usually have a poor prognosis.
Obesity
Obesity, especially when accompanied by diabetes and high blood pressure, has been associated with a less favourable prognosis.