Endometrial carcinoma: causes of death and sites of treatment failure

A retrospective analysis of causes of death in 398 patients with endometrial carcinoma and sites of treatment failure in 105 cases, all seen at the University of Michigan Medical Center between 1930 and 1971, is the subject of this report. Of 398 patients (337 with Stage I, 61 with Stage II disease), 183 (46%) died with endometrial carcinoma, and 122 (31%) died free of cancer. The cause of death in 35 cases (9%) was a known or unknown maligancy, and remained undetermined in 58 patients (14%). The exact site of treatment failure was identified in 105 cases. Forty-one (40%) failures were considered local, 32 (30%) geographic, and 32 (30%) both local and distant. The uterus and lungs were the most common sites of local failure and distant metastasis, respectively. Of patients who died free of cancer, 88% survived 5 or more years, and 32% survived 20 years or longer. It is concluded that 1) Hematogenous dissemination of endometrial carcinoma may occur early and with appreciable frequency. Thorough pretreatment investigative workup, preferably including chest laminograms and liver scans and consideration of adjuvant systemic therapy in advanced cases (i.e. those with positive nodes) is recommended. 2) The uterus, a common site of local failure, must be removed whenever feasible. 3) A realistically aggressive approach to the treatment of patients with endometrial cancer is justifiable despite their older age and coexistent medical problems.