Uterine Serous Carcinoma

Uterine serous carcinoma (USC) is a rare type of cancer in your uterus. It accounts for about 10% of all uterine cancer cases. It’s a high-grade cancer, which means it’s aggressive.

This information can be difficult to absorb. Researchers are actively working on new ways to treat uterine serous carcinoma. Your healthcare team will walk you through all your options.

Stages

Healthcare providers stage uterine cancers, including USC, on a scale that ranges from I to IV. It’s based on if and where the cancer has spread in your body (metastasized). You’ll likely need to have surgery so your provider can accurately stage USC. The stages include:

• Stage I: The cancer is just in your uterus.
• Stage II: It’s spread to your cervix.
• Stage III: It’s spread to your vagina, ovaries and/or lymph nodes.
• Stage IV cancer: It’s spread to your bladder or other organs far away from your uterus.

Each of these stages has substages based on the tissues involved and the depth of the cancer cells. Your cancer care team will explain which stage you have in detail.

Almost half of females with uterine serous carcinoma have stage II to IV disease at the time of diagnosis.

Symptoms of uterine serous carcinoma

Symptoms of uterine serous carcinoma may include:

• Heavy periods or vaginal bleeding between periods before menopause
• Vaginal bleeding or spotting after menopause — even a slight amount
• Thin white or clear vaginal discharge if you’re postmenopausal
• Bloating
• Feeling pressure in your pelvis
• Pelvic pain
• Unexplained weight loss
• Changes in bowel function
• Changes in bladder function

Signs of USC can resemble those of many conditions. If you notice unusual pain or irregular vaginal bleeding, talk to your healthcare provider. An accurate diagnosis is key so you can get the right treatment.

Uterine serous carcinoma causes

Researchers are still learning about the causes of USC. Cells in the uterus develop mutations, or changes in their DNA. The mutated cells grow out of control and form a tumor.

So far, researchers have found several gene mutations linked to USC.

Risk factors

Risk factors for uterine serous carcinoma include:

• Being over age 55
• History of breast cancer
• Tamoxifen usage (an antiestrogen medication to help treat breast cancer)
• Hereditary breast-ovarian cancer syndrome (HBOC)

Black women are more likely to be diagnosed with USC compared to Hispanic and non-Hispanic white women.

How doctors diagnose this condition

To start, your healthcare provider will ask about your symptoms, medical history and risk factors. They’ll do a physical and pelvic exam. They’ll need to remove a sample of tissue (biopsy) to confirm the diagnosis. Ways to do this include:

• Endometrial biopsy
• Hysteroscopy
• Dilation and curettage (D&C)

Your provider will then send the tissue sample to a lab. A pathologist will look at it under a microscope to see whether it’s cancer or not.

Your provider may recommend other tests, like imaging and blood tests.

How is it treated?

Treatment for uterine serous carcinoma — regardless of the stage — typically involves surgery and adjuvant (extra) therapy with chemotherapy or radiation. This is to decrease the rate of this cancer coming back (recurring).

Surgery

In early-stage USC, surgery is the main treatment. Surgery types include:

• Removing your uterus, cervix, fallopian tubes and ovaries
• Omental biopsy (taking a small sample of your omentum, a fatty tissue that covers your abdominal organs)
• pelvic washings (collecting fluid from your abdominal cavity to check for cancerous cells)
• Sentinel node (lymph node) biopsy

In advanced-stage USC, removing as much of the tumor as possible (debulking) is the most common surgical approach.

Adjuvant therapy

Adjuvant therapy targets cancer cells that surgery didn’t destroy. For USC, chemotherapy is the most common adjuvant therapy. Other treatments may include:

• Targeted therapy
• Immunotherapy
• Radiation therapy

Your cancer care team will walk you through your treatment options. They’ll make a plan that’s unique to your needs and goals.

They may ask if you want to join a clinical trial. These are studies that test out new therapies to treat conditions like cancer. There are ongoing studies to try out combinations of therapies that may treat various stages of USC.

It may be helpful to ask your cancer care team the following questions:

• Can I join a clinical trial?
• What’s the goal of my treatment?
• How will I know if the treatment is working?
• What side effects should I expect?
• What are the chances that the cancer comes back?
• What will my options be if the cancer comes back?
• What symptoms should I watch out for?

When should I see my healthcare provider?

Due to the high risk of USC coming back after treatment, you’ll see your healthcare provider often. They’ll likely recommend frequent visits in the first two to three years after treatment. Then, you’ll have twice-yearly exams until five years after treatment.

What is the prognosis for someone with uterine serous carcinoma?

Your prognosis (outlook) depends on many factors, including your general health, other medical problems and the stage of the cancer. Compared to other, more common types of endometrial cancer, USC tends to have a more challenging prognosis. It also has a higher chance of coming back (recurring). Researchers estimate the recurrence rate to be 31% to 80% even in its early stages.

According to one study, the estimated five-year survival rate for stage I to II USC is 74%. The five-year survival rate for stage III to IV is 33%. It’s important to remember that these are only estimates based on one study of a group of people. You’re not those people — you and your situation are unique. Researchers are currently working on new developments in USC treatments. This will change these survival rates.

Your healthcare team will give you a better idea of what to expect.