Prognosis and survival for uterine cancer

A prognosis is the doctor’s best estimate of how cancer will affect you and how it will respond to treatment. Survival is the percentage of people with a disease who are alive at some point in time after their diagnosis. Prognosis and survival depend on many factors.

The doctor will look at certain aspects of the cancer as well as characteristics of the person (such as their age). These are called prognostic factors. The doctor will also look at predictive factors, which influence how a cancer will respond to a certain treatment and how likely it is that the cancer will come back after treatment.

Prognostic and predictive factors are often discussed together. They both play a part in deciding on a prognosis and a treatment plan just for you. Only a doctor familiar with your medical history, the type and stage of the cancer, the molecular subtype and other features of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis and chances of survival.

The following are prognostic and predictive factors for uterine cancer.

Molecular subtype is a classification given to endometrial carcinoma based on whether it has certain genetic mutations.

POLEmut endometrial carcinoma usually has a better prognosis.

MMRd endometrial carcinoma has an intermediate prognosis.

p53abn endometrial carcinoma is usually more aggressive and has a less favourable prognosis.

Grade is one of the more important prognostic factors. Grade 1 or 2 tumours have a better prognosis and are less likely to come back, or recur, than grade 3 tumours.

Lymphovascular space invasion (LVSI) is when uterine cancer cells are found in the lining of blood vessels or vessels of the lymphatic system. LVSI increases the risk of uterine cancer spreading to the lymph nodes nearby (called regional lymph nodes) and is associated with a less favourable prognosis.

Myometrial invasion is how far the tumour has grown into, or invaded, the middle layer of the uterus wall (called the myometrium). Doctors can use the degree of myometrial invasion to predict if the cancer will come back (recur) and to predict survival. The deeper the tumour has grown into the myometrium, the poorer the prognosis.

Myometrial invasion is closely linked to the grade of the tumour. A higher grade tumour has a greater chance of growing into the myometrium.

Stage 1 cancers have the most favourable prognosis.

Advanced cancer has a less favourable prognosis because it has spread outside of the uterus to the lymph nodes, cervix or structures in the pelvis and abdomen (also known as extra-uterine disease).

Endometrial carcinomas have a more favourable prognosis than uterine sarcomas.

Some types of tumours within these groups have more favourable prognoses than others. For example, endometrioid carcinomas have a more favourable prognosis than serous adenocarcinomas. Also, endometrial stromal sarcomas have a more favourable prognosis than uterine leiomyosarcomas.

The presence of progesterone receptors on cancer cells may be linked with a less aggressive cancer. Cancer cells that have progesterone receptors have a better response to hormonal therapy and a more favourable prognosis.

Find out more about hormone receptor status testing.

The HER2 gene controls a protein on the surface of cells that promotes their growth. HER2-positive uterine cancer means that the cancer cells make too many copies of, or overexpress, the HER2 gene.

HER2-positive uterine cancer is more aggressive than HER2-negative uterine cancer. This means that it's more likely to grow, spread and come back after treatment.

HER2-positive cancer has a better chance of responding to treatment that includes drugs that target the HER2 protein. But it still has a less favourable prognosis than HER2-negative uterine cancer.

Find out more about HER2 status testing.

Cancer that occurs in people 40 years of age and younger tends to have a better prognosis than cancer that occurs in people over the age of 40.

Older people often have a more aggressive type of tumour and more advanced disease, which can result in a less favourable prognosis.

Obesity, especially combined with diabetes and high blood pressure, has been linked with a less favourable prognosis.