USPC/Clear Cell ? (Recap of Lost Posts, Topic Created by Ribbons on Jan 20, 2019)

This recap includes posts that were lost during CSN's data outage from 10/29/18 to 1/30/19.

Ribbons

Jan 20, 2019 - 2:20 pm

I get confused by these labels. What exactly is the difference between USPC and clear cell cancer? Or are they the same?? My pathology report said mostly clear cell 

 

Forherself

Jan 20, 2019 - 3:10 pm

Histology

I think even a lot of pathologists couldn't answer your question.  I did find this little blurb.  You might have to look up a few of the words.  

Histology

Uterine papillary serous carcinoma

UPSC was first described in the 1980s. These tumors are characterized by a complex papillary architecture, broad fibrous stalks lined with a stratified epithelial lining, tumor necrosis, increased mitotic figures, and increased nuclear-to-cytoplasmic ration. Thirty percent of cases may also have psammoma bodies, which are often seen in papillary serous ovarian cancer.

Clear cell carcinoma

CC may exhibit a wider variety of histologic characteristics. The papillary form of CC is the most common. Other types include tubulocystic or solid. Common features include intraluminal mucin and intracytoplasmic vacuoles. These tumors are typically estrogen receptor and progesterone receptor negative (as is UPSC). p53 staining is less common for CC than UPSC and can be used in differing the two histologies.

If your slides had any USC in them, they treat it as for USC, even 5%.   I think your pathology report would say if you were p53 positive.  Mine did and I was.   I think the management of both types is pretty much the same from what I have read.  It is hard to read the studies because A1 has many levels.  They changed the staging system for UPSP a few years ago.   If I had residual cancer cells in my uterus, I think I would opt for treatment.  That seems to be the most common recommendation.  Find a doctor you trust and ask them what they would do if they were sitting in your chair.  

 

Ribbons

Jan 20, 2019 - 3:54 pm

Thank you,

I am currently doing chemo, I am undediced about brachytherapy, that scares me more than the chemo! I am very scared of any type of radiation.

 

BluebirdOne

Jan 20, 2019 - 9:57 pm

Ribbons

I had three rounds of brachytherapy sandwiched between chemo.  I am 1a, grade 3, with LVSI. I, too, was very frightened about the treatment and while it was mildly uncomfortable (and pretty embarrassing) it was really doable. I had a tiny bit of bleeding afterward which resolved in a few days. I was freaked out by the notion of radiation, but after reading the why and discussing it with my doctor, I reluctantly went ahead. With UPSC, I didn't want to take a chance that there were cells that could have grown in the vagina after having the tumor (radical hysterectomy) removed. Local recurrence is in the vagina most often. I did not have the pelvic external radiation as my doctors wanted to hold that treatment back in case of a recurrence. My side effects were mostly diarrhea, (long since resolved) and my bladder and bowel functions are not 100% but I believe that is due to surgery. 

Hope this helps. 

Denise 

 

derMaus

Jan 20, 2019 - 11:33 pm

Bracytherapy is basically

Bracytherapy is basically just a radioactive dildo, inserted for 3-5 minutes at a stretch. That's it. Of all the indignities my body has been put through for treatment, it's had the least effect on me of any. Have no fear, you'll do well. 

 

Ribbons

Jan 22, 2019 - 5:18 pm

OK

Thanks, that is what it sounds like!

 

BluebirdOne

Jan 22, 2019 - 6:02 pm

Brachytherapy dildo

That is exactly what it was like. Except you are in a well lit room with a bunch of people staring at your hoo haw. Very undignified. 

 

Ribbons

Jan 22, 2019 - 6:44 pm

Lol

Thanks, that made me laugh out loud!!

 

evolo58

Jan 20, 2019 - 7:43 pm

The staging for UPSC was changed?

I know some medical professionals feel certain parts of the staging should be changed, but is this official? If so, where can I see the description of these stages? Thanks

 

Ribbons

Jan 22, 2019 - 5:17 pm

I think I get it now

I think it is like squares and rectangles, all squares are rectangles, but not all rectangles are squares. So clear cell is a UPSC but not all UPSC is clear cell. Right?

 

Forherself

Jan 23, 2019 - 12:40 am

I think that is right

I think that is right about the squares and rectangles being like USC and Clear Cell.  

 

Forherself

Jan 20, 2019 - 8:04 pm

From Cancer.net

Uterine Cancer: Stages and Grades

Approved by the Cancer.Net Editorial Board, 06/2017

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. Use the menu to see other pages.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body.

Doctors use diagnostic tests to discover the cancer's stage, and they may need information based on samples of tissue from surgery, so staging may not be complete until all of the tests are finished and the surgery to remove the tumor has been done (see Treatment Options). Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a woman's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer. For uterine cancer, the staging system developed by the International Federation of Obstetrics and Gynecology (Federation Internationale de Gynecologie et d'Obstetrique or FIGO) is used.

FIGO stages for uterine cancer

The stage provides a common way of describing the cancer, enabling doctors to work together to plan the best treatments. Doctors assign the stage of endometrial cancer using the FIGO system.

Stage I: The cancer is found only in the uterus or womb, and it has not spread to other parts of the body.

Stage IA: The cancer is found only in the endometrium or less than one-half of the myometrium.

Stage IB: The tumor has spread to one-half or more of the myometrium.

Stage II: The tumor has spread from the uterus to the cervical stroma but not to other parts of the body.

Stage III: The cancer has spread beyond the uterus, but it is still only in the pelvic area.

Stage IIIA: The cancer has spread to the serosa of the uterus and/or the tissue of the fallopian tubes and ovaries but not to other parts of the body.

Stage IIIB: The tumor has spread to the vagina or next to the uterus.

Stage IIIC1: The cancer has spread to the regional pelvic lymph nodes

Stage IIIC2: The cancer has spread to the para-aortic lymph nodes with or without spread to the regional pelvic lymph nodes

Stage IV: The cancer has metastasized to the rectum, bladder, and/or distant organs.

Stage IVA: The cancer has spread to the mucosa of the rectum or bladder.

Stage IVB: The cancer has spread to lymph nodes in the groin area, and/or it has spread to distant organs, such as the bones or lungs.

Grade (G)

Doctors describe this type of cancer by its grade (G), which describes how much cancer cells resemble healthy cells when viewed under a microscope.

The doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together. If the cancer appears similar to healthy tissue and contains different cell groupings, it is called differentiated or a low-grade tumor. If the cancerous tissue looks very different from healthy tissue, it is called poorly differentiated or a high-grade tumor. The cancer’s grade may help the doctor predict how quickly the cancer will spread. In general, the lower the tumor’s grade, the better the prognosis.

The letter "G" is used to define a grade for uterine cancer.

GX: The grade cannot be evaluated.

G1: The cells are well differentiated.

G2: The cells are moderately differentiated.

G3: The cells are poorly differentiated.

Recurrent uterine cancer

Recurrent cancer is cancer that has returned after treatment. Uterine cancer may come back in the uterus, pelvis, lymph nodes of the abdomen, or another part of the body. If there is a recurrence, this tends to occur within 3 years of diagnosis, but later recurrences can sometimes occur. Some symptoms of recurrent cancer are similar to those experienced when the disease was first diagnosed.

Vaginal bleeding or discharge

Pain in the pelvic area, abdomen, or back of the legs

Difficulty or pain when urinating

Weight loss

Persistent cough/shortness of breath

If there is a recurrence, more testing will help to determine the extent of disease. You and your doctor should talk about treatment options.

Information about the cancer’s stage and grade will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. You may use the menu to choose a different section to read in this guide. 

 

Forherself

Jan 20, 2019 - 8:06 pm

About the change in staging,

Int J Gynecol Cancer. 2012 Mar;22(3):452-6. doi: 10.1097/IGC.0b013e31823de6dd.

Outcomes of patients with uterine serous carcinoma using the revised FIGO staging system.

Seward S1, Ali-Fehmi R, Munkarah AR, Semaan A, Al-Wahab ZR, Elshaikh MA, Cote ML, Morris RT, Bandyopadhyay S.

Author information

Abstract

OBJECTIVE: 

Our aim was to evaluate the prognostic significance of the revised 2009 International Federation of Gynecology and Obstetrics (FIGO) staging criteria in patients with uterine serous carcinoma (USC).

MATERIALS AND METHODS: 

We retrieved clinical and histopathologic data on women with USC from 2 large academic centers. Age, race, stage, myometrial invasion, angiolymphatic invasion, and adjuvant therapy were analyzed using Kaplan-Meier and Cox regression models.

RESULTS: 

A total of 168 patients were included. Three-year survival rate was 81% for revised stage I, 52% for stage II, 46% for stage III, and 19% for stage IV. Survival was not significantly different when comparing overall 1988 FIGO stage I or II to 2009 FIGO stage I or II. The 3-year survival rate for 1988 stage IA (93%), IB (75%), and IC (60%) significantly differed (P = 0.02). When patients were restaged using the 2009 staging system, the 3-year overall survival of 2009 stage IA dropped to 83.4% and 68.8% for stage IB. New FIGO stage, myometrial invasion, angiolymphatic invasion, and administration of chemotherapy all remained independent predictors of survival on multivariate analysis (P < 0.05). Of note, extrauterine disease was observed in 22% of patients without myometrial invasion. Age and race were not prognostic factors for either classification.

CONCLUSIONS: 

The streamlined 2009 FIGO criteria do not adequately delineate survival for USC in early-stage disease. The 1988 FIGO classification correctly identified 3 subgroups of stage I USC patients with significantly different survival that is lost with the elimination of the most favorable 1988 stage IA subgroup. Because evaluation for adjuvant therapy and patient planning may change based on survival information, further evaluation of more appropriate USC staging is warranted. Caution should be taken when evaluating therapeutic response and comparing studies using these revised criteria in the future.