How does the subtype of endometrial cancer impact treatment options? Expert Dr. Dario Roque reviews the different types of endometrial cancer, their associated risk profiles, and how these factors help guide treatment decisions.
Dr. Dario Roque is a Gynecologic Oncologist and an Associate Professor of Gynecologic Oncology at Northwestern Medicine. Learn more about Dr. Roque.
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Transcript
Katherine Banwell:
Dr. Roque, are there subtypes of endometrial cancer that patients should understand when discussing their treatment options with their provider?
Dr. Dario Roque:
Yes, historically, we always thought about endometrial cancer as having two main types. So, what we usually defined as type I were the least aggressive types of endometrial cancer. Those are usually what are called endometroid, and that just refers to the histological subtype. And those cancers are still cancer, but they tend to be slower growing. A lot of times, they can be associated with excess estrogen exposure. For example, women who were receiving hormone therapy after menopause, so any sort of risk factor that increases the amount of estrogen, those are the types of cancer that those women will develop.
In general, they tend to be, as I mentioned, less aggressive. They tend to be diagnosed at earlier stages.
So, usually surgery by itself could be curative if diagnosed at an early stage. And then there are the endometrial cancers that historically were considered to be type II. Those tend to be more aggressive, if you will, in the sense that even when they appear to be early stages in the uterus, they can spread to the lymph nodes and other places in the body. Those types include cell types that are known as either serous endometrial cancer or clear cell endometrial cancer. There are also carcinosarcomas. Those are probably the main subtypes in that category.
In general, in patients that have those type II histological cell types, we almost always recommend chemotherapy after surgery, even if the cancer is diagnosed in an early stage, when that is not necessarily the case in patients that have that endometrioid or type I cell type. However, as we have come to understand endometrial cancers better, and we are doing more and more molecular testing, that type one versus type two categorization is somewhat antiquated in a way.
So, we still use it, but we’re probably transitioning more to this molecular cell typing to help us make treatment recommendations.