Case Overview: A 71-Year-Old Woman With Endometroid Adenocarcinoma


Expert Matthew A. Powell, MD, reviews the diagnosis, treatment, and recurrence of a 71-year-old woman who presents with endometroid adenocarcinoma.

Matthew A. Powell, MD
: Today we have a case of a 71-year-old woman with endometrioid adenocarcinoma of the uterus, [which] initially presented back in July 2021. At that point the patient had abnormal uterine bleeding with increasing urinary frequency, and nausea and cramping for about 6 months. Her past history and clinical workup [showed] she had 2 grown children with no known family history of cancer and a body mass index of 32. She has type 1 diabetes since childhood, which is well controlled with current medications. A physical exam was noted for a mildly enlarged uterus with right lower quadrant abdominal tenderness on palpation. She had a good ECOG performance status of 1. She underwent a CT scan showing uterine and bladder masses and had a CA 125 [test] notable for slight elevation of 38.6. For initial diagnosis and treatment, the patient had an endometrial biopsy performed that revealed an endometrioid adenocarcinoma. Ultimately [it] was found to be stage 4A with the involvement of the bladder, and was grade 3, which was poorly differentiated. Had immunohistochemistry studies performed that showed this to have proficient mismatch repair, otherwise known as microsatellite stable. HER2 testing was done and was negative. NTRK fusion was also negative and was found to be ER [estrogen receptor] negative. She underwent germline testing, which showed no pathologic variants. The patient was started on carboplatin, paclitaxel, and chemotherapy. She tolerated the treatment quite well other than developing some grade 1 peripheral neuropathy, some nausea, and vomiting. Four months after the initiation of treatment, she had no evidence of disease on a PET [positron emission tomography] CT scan and with complete resolution of all of her symptoms. Unfortunately, in July 2022, 12 months after the completion of chemotherapy, she presented with the rising CA 125 and a CT scan showing growth of the bladder mass and new suspicious peritoneal abdominal lymph nodes. A PET scan was performed that showed intense FDG [fluorodeoxyglucose] uptake not only in the abdomen, but also in the lungs, peritoneal bass lesions, and including avid periodic lymph nodes. A bronchoscopy was performed which demonstrated, unfortunately, recurrence of her endometrioid carcinoma. At this point, the patient was treated for recurrence with a combination of lenvatinib plus pembrolizumab.

Unfortunately, this case is all too common. As we know, this…clinical case does show the efficacy of carboplatin and paclitaxel, which is quite good. But, unfortunately, these patients often recur in the second- and third-line therapies. As we step back a little bit and look at risk factors for endometrial cancer, which is one of our few cancers actually increasing in incidence, a lot of this is tied to the increased amount of obesity within the Western world and within our population. Certainly, this patient has some risk factors for that. Also, diabetes mellitus. Diabetes by itself will also increase our risk of endometrial cancer. There are other things that we note when we look at some of the risk factors, but this increasing rise of degressive subtype is also going on. We think some of that is the aging of the population. Unfortunately, there’s a big disparity with our Black and African American patients, noting a very much increased amount of the aggressive histologic subtypes. Now, when we talk about diagnostic testing, this patient underwent appropriate testing with an endometrial biopsy, which confirmed the cancer, then had imaging done mostly due to the fact that there was a high-grade cancer, as well as the fact that there were findings on the exam. Notably, the enlarged uterus as well as suspicious areas within the bladder on the exam with increasing pain. So a CT scan was appropriately performed. Additional diagnostic testing at this point will be discussed as we look into molecular testing.

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