Didactics-Updates in Endometrial Carcinoma Classification

Video Transcription
Video Summary
In this video presentation, the speaker discusses the molecular classification of endometrial cancer. They explain that the 2020 WHO book incorporated molecular classification into the histology classification of endometrial carcinoma for the first time. They highlight the problem of inter-observer disagreement on the histotype of endometrial carcinoma and the difficulty in identifying certain types of tumors. The speaker introduces new players in the classification, including mesonephric adenocarcinoma and mesonephric-like tumors, which have a key feature of KRAS mutation. The speaker also clarifies that mucinous carcinoma should not be mistaken for gastric-type carcinoma and is now called endometrioid carcinoma. They discuss the importance of integrated genomic characterization and the four molecular classes independent of histotype: polymutated, polymerase epsilon mutated, hypermutated, copy number low, and copy number high. The speaker emphasizes the importance of this classification for determining treatment options and prognosis. They discuss the benefit of adjuvant chemotherapy for patients with P53 abnormal endometrial carcinomas and the lack of benefit for poly-mutant adenocarcinomas. The speaker highlights the Vancouver group's proposed PROMIS genomic-based clinical classifier for endometrial cancer and its implications for testing MMR, poly-mutation, and P53 abnormality. They also explain the risk stratification for endometrial cancer based on the molecular subtypes. The speaker mentions a study showing moderate consensus among pathologists in determining molecular groups and histological subtypes. They discuss the association of MMR deficient tumors with Lynch syndrome and the aggressive features of MLH1-methylated endometrial cancer. The speaker concludes by stating that 95% of endometrial cancer can be classified based on a single molecular subtype, and the impact of this classification on clinical outcomes and treatment options. They emphasize the importance of proper workup and testing for decision-making on adjuvant therapy.
Asset Subtitle
Anna Plotkin
July 2022
Keywords
molecular classification
endometrial cancer
histology classification
treatment options
prognosis