Endometrial cancer: Part II. Multimodality treatment of uterine high-grade serous carcinoma (clinical course I)

Endometrial cancer (EC) is the most frequently diagnosed gynecological malignancy with rapid growth of incidence in the high-income countries and Taiwan. Since the integration of modern molecular pathology into traditional clinico-pathology for the diagnosis and classification of EC, the treatment is apparently switched to more precise molecular-guided or -targeted therapy, having been reviewed in the part I (2022). The current review is the part II describing the previous history (clinical course I) of the complex clinical course occurred in a 66-year-old woman with uterine high-grade serous carcinoma (HGSC, post-curettage diagnosis), who was treated with robotic staging surgery without additional postoperative adjuvant therapy due to absence of any residual malignancy in February 2019 (Rationales and controversial issues 1-5). Recurrences at the multiple sites, including vaginal cuff, liver, adrenal and lung metastases occurred in December 2020. Suboptimal cytoreductive surgery and following 6 cycles of paclitaxel-carboplatin regimen between January and April 2021 achieved nearly complete remission (Rationales 6,7 and controversial issues 6,7 for the first recurrence). However, this equivocal clinical situation made the following treatment in confusion. Using positron emission tomography/magnetic resonance image (MRI) or computed tomography (CT) not only serving as a valuable tool for detecting occult metastatic lesions but also giving an answer for uncertain clinical diagnosis provided the additional therapy (Rationales 8-10 and Controversial issues 7-9). This case highlights an aggressive nature of uterine HGSC, even though the initial diagnosis was an early-stage disease (no residual tumor) and the hospital shopping makes the clinical course much complex. This part II (Clinical course I) has explored the first journey from the initial diagnosis and initial treatment at the hospital "A" and "B" to the subsequent management of the recurrent disease at the hospitals "C,D,E,F", including the rationale and controversial issues in the clinical course I.