Having synchronous cancers means better survival outcome

New research published in this month's edition of Obstetrics & Gynecology (Vol. 113, Issue 4), by a team of investigators from The Cancer Institute of New Jersey (CINJ) shows better survival outcomes for women who have cancer of the ovaries and endometrial lining of the uterus at the same time (synchronous) than those who only have one tumor in the ovaries.

CINJ is a Center of Excellence of UMDNJ-Robert Wood Johnson Medical School.

The study, Synchronous Primary Ovarian and Endometrial Cancers: A Population-Based Assessment of Survival, utilized a massive data set from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program, which collects and compiles information on cancer cases representing about one quarter of the U.S. population. Registries from New Jersey, Connecticut, Los Angeles and other large metropolitan areas were targeted, which yielded data on more than 85,000 women - both those who were diagnosed with primary ovarian cancer and those with synchronous primary ovarian and endometrial cancers between 1973 and 2005.

While the definition for synchronous cancer can vary, the CINJ team utilized the SEER definition, which is one being diagnosed with endometrial or ovarian cancer within two months of the other. Researchers note this characterization should not be confused with the metastasis - or spread - of disease from one tumor site to another.

Once exclusion criteria were applied, results were based on 55,348 single ovarian cases and 1,355 synchronous ovarian and endometrial cancer cases. Among women with synchronous cancers, 70 percent had endometrial tumors diagnosed at a localized stage and 75 percent were in an earlier stage of disease. A previous study has shown that 75 percent of endometrial cancers are detected in earlier, treatable stages. Authors of this study conclude synchronous cases may have a lead-time advantage over single ovarian tumors due to the presence of irregular bleeding, which prompts earlier examination and treatment.

According to the American Cancer Society, 40,000 new cases of endometrial cancer were diagnosed in the United States last year, with 7,400 deaths, while there were more than 22,000 new cases of ovarian cancer and more than 15,000 deaths. Having both cancers diagnosed within a short time of one another is relatively uncommon.

Melony G. Williams, MPH, who is a research training specialist and project coordinator at CINJ and UMDNJ-Robert Wood Johnson Medical School, and a doctoral student at UMDNJ-School of Public Health, is the lead author on the paper. She notes, "While synchronous cancers are rare, their identification and optimal clinical management are key in the battle to reduce ovarian cancer deaths. The development of a national registry to document these cases and the means to collect and review such data would help to achieve this goal."

According to Williams, other factors that may affect survival such as family history, income, education, health insurance, recurrences and co-morbidities were not included, because they were not available in the SEER database, but that future studies should aim to address these issues.

Along with Williams, the author team consists of Elisa V. Bandera, MD, PhD, epidemiologist at CINJ and assistant professor of epidemiology at UMDNJ-Robert Wood Johnson Medical School and the UMDNJ-School of Public Health; Kitaw Demissie, MD, PhD, MPH, co-program leader of CINJ's Population Science Program and associate professor of epidemiology at UMDNJ-School of Public Health; and Lorna Rodriguez, MD, PhD, chief of gynecologic oncology at CINJ and professor of gynecologic oncology at UMDNJ-Robert Wood Johnson Medical School.