Nonendometrioid Endometrial Carcinomas and Uterine Sarcomas

Certain nonendometrioid endometrial carcinomas, including uterine papillary serous carcinoma (UPSC), clear-cell carcinoma (CCC), and carcinosarcoma, are distinct in their behavior from the more common endometrioid endometrial carcinomas and warrant more aggressive treatment. UPSC represents an unusual and aggressive variant, accounting for 10% of endometrial carcinomas but 39% of deaths from endometrial carcinoma. Serous carcinomas affect older, usually postmenopausal patients, often arising in the setting of endometrial atrophy. Both UPSC and CCC are increased in African Americans. Numerous biological agents have been studied in endometrial cancer though the percentage of nonendometrioid tumors varied from study to study. Uterine sarcomas are usually virulent tumors. They have a high recurrence rate, most of which are distant recurrences. In both early-and advanced-stage disease, multimodality therapy is utilized in an effort to decrease recurrence. Significant advances in chemotherapy or biological therapy are needed to improve the current survival rates.