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Carcinoma of the corpus uteri: a 10-year review of 225 patients.

Data on 225 patients with endometrial adenocarcinoma or adenoacanthoma treated at the Strong Memorial Hospital Rochester New York during the 10-year period beginning January 1957 are compared with an earlier report of 339 patients having a similar diagnosis during the previous 30-year period. Of 16211 patients admitted to the gynecologic service during the 1957-1967 period 784 (4.8%) were found to have malignancies of the genital tract. The 225 patients with endometrial carcinoma represented 28.7% of gynecologic malignancies and 1% of all gynecologic admissions. This incidence was unchanged from that of the earlier series. Only 1 patient was lost to follow-up. 153 patients (77%) had an early stage of the disease 27 (14%) were Stage 2 13 (7%) had Stage 3 and 4 (2%) were classified as Stage 4. 55% of the patients were over age 60 while 14.5% were premenopausal. Abnormal or postmenopausal bleeding had prompted medical consultation in 7.8% of whom 74% reported symptoms of less than 6 months duration. 12% were diabetic and 20% weighed more than 80 kg 15 patients weighing more than 100 Kg. Available reports of cytologic smears were positive in only 25%. Estrogen therapy was not found related to the tumors. 6 patients had had previous oophorectomy. 7.5% had received previous pelvic irradiation. In 8% there were primary malignancies in other organs. 14% had never been married. Of those married 28% were nulliparous. Treatment was surgical with or without radiation therapy. The overall corrected 5-year survival rate was 69%. Of 106 who had not yet reached 5 years since operation 49 died of the disease and 49 patients were alive and without evidence of the disease. Isolated vaginal recurrences were rare. Survival was affected by age at diagnosis stage of disease depth of myometrial invasion and cellular differentiation of the tumors. The younger women fared better than those over age 60 at the time of diagnosis. 37 developed some form of recurrent disease 25 of these within the first 2 years and 4 after 5 years. Of these 2 had recurrences after more than 10 years. 24 of these 37 patients died of the recurrent disease within 1 year of its recognition. 2 of 11 patients with recurrences who received progestational agents and 4 of 12 who received radiation therapy survived 5 years. The survival of patients with adenocarcinoma and those with adenoacanthoma was the same. It is stated that the uterus should be removed when a bilateral oophorectomy is performed. Uterine radiation should not be used for treatment of benign bleeding problems. Cytological cervical and vaginal smears are not sufficient to rule out endometrial carcinoma. Fractional curettage is needed with early diagnosis and quick definitive therapy.