Endometrial cancer

Endometrial cancer

Epidemiology:

Endometrial cancer is the most commonly diagnosed gynecological malignancy, with hundreds of thousands of new cases reported annually, especially in developed countries. Spontaneous remission (SR) is noted in various malignancies but is exceptionally rare in endometrial cancer ¹. The literature indicates that documented cases of SR in endometrial cancer comprise a small fraction of cases often less than 5% leaving a significant knowledge gap regarding the mechanisms behind such occurrences. Research suggests that SR may involve complex interactions with the immune system and hormonal factors; however, specific mechanisms related to endometrial carcinogenesis remain poorly understood ².

Clinical Characteristics:

To date, five cases of spontaneous regression (SR) involving either primary or metastatic endometrial carcinoma have been documented in the literature. These cases collectively underscore the exceptional rarity and clinical heterogeneity of SR in endometrial malignancies. Reported patient ages at the time of regression ranged from 28 to 77 years, all occurring in females, consistent with the gender-specific nature of this cancer. See Table 1 below for further information.

Histological Characteristics:

Of the cases analyzed, the tumors were primarily reported as originating from the endometrium or uterus, with some involving ovarian or metastatic sites such as the omentum, peritoneum, and lung. Instances of non-endometrial malignancies or unrelated gynecologic tumors were excluded from this data collection to maintain diagnostic consistency and ensure accurate representation of spontaneous regression in endometrial carcinoma.

Proposed Contributing Mechanisms:

Among the reported cases, proposed mechanisms varied considerably. Several reports attributed regression to immune responses, hormonal influences, or vascular factors, while others emphasized the combined impact of psychological, nutritional, and immune modulation, as described in lifestyle-associated regression. A few cases, particularly those involving pregnancy-related changes, highlighted the role of hormonal regulation, especially progesterone-mediated effects, in tumor regression. The remaining reports did not specify any therapeutic or mechanistic interventions. Collectively, these findings suggest that immune responses, hormonal factors, and systemic physiological changes may contribute to the spontaneous regression of endometrial carcinoma.

Site and Extent of Remission:

The majority of documented cases exhibited complete remission localized to the primary endometrial region, while others demonstrated remission at both primary and secondary sites, including the lung, liver, peritoneum, omentum, and adnexae. One patient maintained remission for up to six years, indicating durable disease control in the absence of therapeutic intervention. Although follow-up durations varied among reports, these findings suggest that spontaneous regression in endometrial carcinoma can occasionally result in sustained and clinically significant remission.

Table 1 Endometrial cancer SR Cases and Clinical Characteristics

References:

1. Saso S., Chatterjee J., Georgiou E., Ditri A., Smith J., & Ghaem‐Maghami S. Endometrial cancer. BMJ. 2011;343(jul06 2):d3954-d3954. doi:10.1136/bmj.d3954
2. Ota S., Shinagawa K., Ueoka H., et al. Spontaneous regression of metastatic endometrial stromal sarcoma. Japanese Journal of Clinical Oncology. 2002;32(2):71-74. doi:10.1093/jjco/hyf017
3. Parker R, Lanvin D, Gilks B, Miller D. Spontaneous regression of stage IV clear cell carcinoma of the endometrium in a patient with essential thrombocytosis. Gynecol Oncol. 2001;82(2):395–399. doi:10.1006/gyno.2001.6273
4. Ota S, Shinagawa K, Ueoka H, Tada S, Tabata M, Hamazaki S, Kondo E, Kiura K, Mannami T, Shibayama T, Niiya K, Harada M. Spontaneous regression of metastatic endometrial stromal sarcoma. Jpn J Clin Oncol. 2002;32(2):71–74. doi:10.1093/jjco/hyf017
5. Cheng JY, Kananathan R. Case report: spontaneous remission of metastatic endometrial carcinoma through the Lim Lifestyle. Nutr Cancer. 2012;64(6):833–837. doi:10.1080/01635581.2012.701703
6. Ishii T, Takayama S, Abe M, Kuroda H, Tanaka J, Numata T, Kikuchi A, Ohsawa M, Kaneko S, Saito N, Arita R, Itakura Y. Spontaneous regression of recurrent undifferentiated carcinoma of the endometrium. Intern Med. 2019;58(11):1649–1653. doi:10.2169/internalmedicine.0376-17
7. Daley D, Padwick M, Mistry S, Malhotra V, Vikram RS, Stanciu P. Case report: Spontaneous remission of synchronous endometrial and ovarian cancers following pregnancy. Front Oncol. 2022;12:1001677. doi:10.3389/fonc.2022.1001677