Uterine cancer: different types, latest clinical trials, and side effects on women's fertility

Uterine cancer is the most prevalent gynecologic cancer, which accounts for nearly ۵۰ percent of all cancers diagnosed in the United States. It is the fourth most common cancer among women, with a higher rate of mortality in countries with low to middle income. Malignant uterine cancer includes two types: endometrial cancer (EC) and uterine sarcoma (US), with the latter being rare. Endometrial cancer or EC malignancy is associated with the inner epithelial layer of the uterus and is divided into two types: type I and type II. Type I includes endometrioid adenocarcinomas with grade I and II classifications, while type II endometrioid adenocarcinomas involve grade III cancers with several subtypes including carcinosarcomas, clear cell carcinomas, serous carcinomas, and undifferentiated carcinomas. Uterine sarcomas affect the mesenchymal tissue of the uterus and according to the origin of each tumor, they are categorized into four main types including adenosarcoma, endometrial stromal sarcoma, leiomyosarcoma, and undifferentiated endometrial sarcoma. Recent clinical trials on EC have explored combined immunotherapy using pembrolizumab beside chemotherapy, with an increased progression-free survival (PFS) period for the treated patients. The other clinical trial has been done with another combination therapy using lenvatinib immunosuppressor, combined with pembrolizumab antibody, which also increased the mean PFS in EC patients. The next effective clinical trial has been provided with dendritic cell vaccination which is safely combined with mixed carboplatin/paclitaxel chemotherapy in mEC patients. Additionally, one of the latest therapeutic approaches used for uterine sarcoma was a targeted therapy with pazopanib drug as a tyrosine kinase inhibitor, with an average PFS time of three months for uterine sarcoma and four and a half months for non-uterine soft tissue sarcoma. The other recently used chemotherapy approach in US patients has also applied a combination of paclitaxel with carboplatin drugs, however, it has not revealed a positive effect on the treatment of progressive uterine sarcoma. Importantly, uterine cancers can affect women's fertility through hormonal imbalances (the imbalance between estrogen and progesterone), interventions such as chemotherapy (because of its cytotoxic and chemical-based nature, it can damage ovarian function, exactly ovarian follicles) and radiation therapy (can damage ovarian tissue because of the radiation field, which is around the pelvis, so the number of ovarian follicles can be decreased), and surgical interventions such as hysterectomy (due to removal of the entire uterus) and oophorectomy (due to eliminating of one or both ovaries)

کلیدواژه ها:

uterine cancer ، clinical trials ، fertility ، cancer ، infertility