Prognosis and survival for uterine cancer

If you have uterine cancer, you may have questions about your prognosis. A prognosis is the doctor’s best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your medical history, the type, stage and characteristics of your cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis.

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. 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 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 is how far the tumour has grown into, or invaded, the middle layer of the uterus wall (called the myometrium). Doctors can use the degree of myometrial invasion to predict if the cancer will come back, or recur, and to predict survival. The deeper the tumour has grown into the myometrium, the poorer the prognosis.

Doctors often classify the degree of myometrial invasion as:

• none – the tumour hasn’t grown into the myometrium
• superficial – the tumour has grown less than halfway through the myometrium
• deep – the tumour has grown more than halfway through the myometrium

Myometrial invasion is closely linked to the grade of the tumour. A higher grade tumour has a greater chance of growing into the myometrium.

Stage 1 cancers have the most favourable prognosis. Cancers have a less favourable prognosis if they have spread outside of the uterus, including to the following:

• lymph nodes
• cervix
• structures in the pelvis and abdomen (also known as extra-uterine disease)

Endometrial carcinomas have a more favourable prognosis than uterine sarcomas. Some types of tumours 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 uterine leiomyosarcomas.

When cancer cells are in the fluid in the abdominal cavity (called peritoneal fluid), it often means that the cancer has spread outside the uterus. This prognostic factor is often linked with other factors, such as how deep the tumour has grown into the myometrium and if the cancer has spread to lymph nodes. Cancer cells in the peritoneal fluid (called positive peritoneal cytology) often means the cancer is more aggressive and it has a less favourable prognosis.

The presence of progesterone receptors on the cancer cells may be linked with a less aggressive cancer. Cancer cells that have progesterone receptors have a better response to hormonal therapy and a more favourable prognosis.

Younger women tend to have a better prognosis than post-menopausal women. This is true even though younger women may not be diagnosed with uterine cancer based on their symptoms as quickly as older women. Younger women often have lower grade tumours that are found at an earlier stage and haven’t grown very deep into the myometrium. Older women often have a more aggressive type of tumour and more advanced disease. As a result, older women tend to have a less favourable prognosis.

Obesity, especially when the woman also has diabetes and high blood pressure, has been linked with a less favourable prognosis.