Stage II endometrial adenocarcinoma. Memorial Hospital for Cancer, 1949-1965

Of 617 patients receiving initial therapy for endometrial adenocarcinoma from 1949 to 1965, 90 patients were retrospectively assigned to Stage II (FIGO) by reviewing preoperative, operative, and pathologic findings. In 66 patients (73%) the cervical spread of endometrial cancer was occult and detected only microscopically in the hysterectomy specimen, whereas in the other 24 (27%) it was detected clinically prior to surgery. The survival rate for patients with occult cervical involvement was better (61%) than in those patients with gross cervical spread of tumor (48%), but the difference was not statistically significant. When the surgical specimen revealed that the only spread was to the cervix, those having only occult spread had a better 5-year corrected survival rate (89%) than those with grossly detectable spread (57%). Spread of tumor beyond the uterus occurred in over one-third of the patients with each kind of cervical spread. Study of lymphadenectomy specimens in 31 patients revealed a similar incidence of lymph node metastases for both groups: 25% in those with grossly detectable spread and 21% in those with occult spread. Only 1 of the 7 patients with positive pelvic lymph nodes had clinically positive paraaortic nodes in addition to the positive pelvic nodes. Thus, only 1 of the 31 patients having the stnadard pelvic lymph node dissection was found to have paraaortic metastasis, as it was routine to sample only clinically positive paraaortic lymph nodes. These data suggest that in Stage II endometrial adenocarcinoma both gross and occult cervical involvement have a relatively bad prognosis and require aggressive therapy.