A Visual Guide to Uterine Papillary Serous Carcinoma

Uterine papillary serous carcinoma, or UPSC, is a rare form of endometrial cancer -- cancer of the lining of the uterus. UPSC happens in 5-10% of uterine endometrial cancer cases. It can spread faster and may be more likely to come back after treatment than other types of uterine cancer, even if doctors catch it early. It causes about 40% of endometrial cancer deaths.

UPSC is more common in women who are Black, of normal weight, and postmenopausal. There are several gene mutations that may be more common with this disease. Women with this cancer are more likely to have relatives who have endometrial, ovarian, and especially pancreatic cancer.

UPSC’s most common symptom is postmenopausal bleeding. If you have this type of cancer, you may also notice pain during sex, pelvic pain, and weight loss that’s not on purpose or that you can’t explain. You may also have an abnormal Pap test at your regular gynecological exam.

To diagnose UPSC, your doctor may take a sample of tissue, called a biopsy, from your endometrium to test for cancer. But these aren’t always sensitive at picking up UPSC. Pelvic ultrasound is another way to diagnose this condition. This imaging scan measures the thickness of a stripe in your uterus that may indicate a problem. 

Women with UPSC often don’t notice symptoms until their cancer has spread beyond the uterus. The first step is surgery. In a laparotomy, your surgeon opens your abdomen and examines organs around your uterus to see if and how much your cancer has spread. This is called staging the tumor.

During a laparotomy, your surgeon removes samples of tissue and lymph nodes to biopsy. You may also have a pelvic wash. Doctors will rinse the inside of your pelvis with saline that they collect and test for cancer cells. Your surgeon may opt for a laparoscopy, which is less invasive.

UPSC treatment starts with a hysterectomy to remove the uterus. Your surgeon also takes out your fallopian tubes, ovaries, any visible tissue affected by cancer, and lymph nodes. They’ll test these to see how much the disease has spread. In stage II cancer, they may remove your cervix and upper vagina, too.

After surgery, UPSC is treated with radiation, chemotherapy, or both. Doctors use radiation to treat localized cancer or to keep cancer from coming back. But it isn’t that effective as a stand-alone treatment. Your doctor may use external beam radiation or brachytherapy. Brachytherapy is when your doctor places a tiny radioactive cylinder in your vagina to kill off cancer cells. They may also try a combination of the two. 

Even in early stages of UPSC, doctors may use chemotherapy to kill cancer cells still in your body after surgery. The drugs they use to treat early-stage UPSC include cisplatin and carboplatin combined with paclitaxel. Sometimes, your doctor will suggest chemotherapy and radiation at the same time, or cycles of both treatments.

In about 30% of women with UPSC, a gene called HER2/neu makes too many copies of itself. A drug called trastuzumab (Herceptin) targets HER2/neu and blocks it. When researchers used it with regular chemo in trials, trastuzumab helped women with UPSC live longer without their cancer getting worse.

Researchers are studying other targeted immunotherapy drugs to treat UPSC. Pertuzumab (Perjeta) blocks even more pathways involved in UPSC than trastuzumab. Lapatinib (Tykerb) blocks HER2 and may tamp down malignant tumor growth.

After UPSC treatment, you’ll see your doctor regularly to check for signs that your cancer has come back or to see how you’re feeling overall. If you notice bleeding from your vagina or rectum, weight loss you can’t explain, pelvic pain, a swollen tummy or legs, a cough, or shortness of breath, call your doctor right away.

UPSC often comes back, even if it’s caught early. About 30%-80% of women with UPSC in stages I and II have cancer that returns. You and your doctor will review treatments based on where your cancer is and how far it has spread. You can also choose palliative care, which will make you feel better but won't treat your cancer, and can be used along with your cancer treatment.

After UPSC treatment, a healthy lifestyle can make your quality of life better. Eat lots of healthy foods. Get enough rest and sleep. Don’t smoke. Be mindful of how much alcohol you drink. Exercise may help you recover after cancer treatment, boost well-being, and ease fatigue and stress. Start slowly and raise your activity level if you feel up to it.