Learn The BasicsThe prognosis of endometrial cancer (EC) is usually positive, especially if the cancer has not spread outside the uterus or womb and to other parts of the body.
Overall, the five-year survival rate of EC is 81%. This means that 81% of women diagnosed with EC are alive five years later. This rate is as high as 95% if the cancer has not spread outside the uterus.
However, in cases where the cancer has spread to other parts of the body, the five-year survival rates can go down to as low as 17%.
According to results from a study conducted in 2020, the overall survival of women with metastatic or recurrent EC is around 15 months after chemotherapy.
These numbers suggest that early diagnosis and treatment can dramatically improve the prognosis of EC. There are also other factors that affect and can improve EC prognosis.
Main factors affecting prognosis
A patient’s prognosis is closely associated with the type of EC they have.
EC can be classified as type 1 or type 2 based on its characteristics. Type 2 EC, which comprises poorly differentiated, aggressive serous, clear cell or carcinosarcoma histological types, usually has a poorer prognosis.
EC can also be classified into four groups based on molecular features. These four groups are POLEmut, MMRd, p53abn and “no specific molecular profile” (NSMP).
The prognosis of EC of POLEmut type is generally excellent, with a five-year relapse-free survival rate of 98%.
MMRd type occurs when the body’s system for fixing DNA mistakes (called mismatch repair) is not working properly. This can happen because of inherited gene changes or because a key gene called MLH1 has been turned off. This type of cancer has an intermediate outlook, with about 77% of people remaining cancer-free five years after treatment.
EC of p53abn type, in which there is a mutation in the TP53 gene, has a poor prognosis with a five-year relapse-free survival rate of 46.6%
Finally, NSMP type, which mainly consists of endometrioid carcinomas, has an intermediate prognosis with a five-year relapse-free survival rate of 74.4%
Improving prognosis
There are three main interventions that can contribute to improving prognosis in EC. These are chemotherapy, genetic testing for Lynch syndrome and screening for other cancers after EC.
It is already known that women with advanced-stage EC have a survival benefit from chemotherapy. However, women with high-risk early-stage EC may also benefit from chemotherapy.
Lynch syndrome is an inherited colorectal cancer caused by a mutation in one of the four MMR genes or the epithelial cellular adhesion molecule (EPCAM) gene. The lifetime risk of colorectal cancer for someone with Lynch syndrome is 80%. Lynch syndrome is also associated with an increased risk of EC, with a lifetime risk of 60%. Identifying patients with Lynch syndrome is therefore important and may help reduce risk of future cancers, including EC, through more frequent surveillance and early treatment.
Women who have survived EC remain at high risk for breast cancer and colorectal cancer. Counseling these women about screening for these cancers can play a crucial role in preventing future cancers.