The value of symptoms and clinical examination in the follow-up after primary therapy for endometrial cancer
Keywords:
Endometriat neoplasms, Recurrence, Survivorship (Public HeaÉth)Abstract
Objective
This study aimed to assess recurrence rate of endometrial cancer regarding frequency, location, symptoms, prognostic factors, diagnostic methods for detecting recurrence, disease-free survival and survival after recurrence.
Methods
A total of 196 women with clinical stage I were submitted to surgery with or without adjuvant treatment, from January 1989 to July 1996. The Kaplan-Meier method and Wilcoxon test were used.
Results
Recurrence occurred in 15.0% of the patients, 86.6% up to 36 months after the surgery. Vaginal carcinoma (40.0%) was the most common, followed by pulmonary and lymph node carcinomas, which were associated with risk factors for recurrence. Fifty percent of the patients were symptomatic and 46.6% of these had distance metastases. All of the symptomatic patients and 2/3 of the asymptomatic patients had abnormal clinical and/or gynecological examinations, calling for other tests. The diagnosis was made by ultrasound and chest radiograph in 1/3 of the
asymptomatic patients. Cancer cytology did not help diagnosis. The presence or
absence of symptoms did not influence disease-free survival or survival after
recurrence. Despite the longer survival of patients with vaginal recurrence, there
was no significant difference when other recurrence sites were compared (p=0.05).
Conclusion
Recurrence in most of the patients occurred in the first three years after treatment.
These patients had signs and/or symptoms which demanded complementary tests
and were associated with bad prognostic factors. The most common recurrence
was vaginal carcinoma and cancer cytology was not helpful. The presence of
symptoms and recurrence site did not influence patient survival. All these results
must be considered in the follow-up protocol.
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References
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