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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In recent years the incidence in endometrial cancer is rising. The relation of cervical to endometrial cancer has shifted to almost 1:1. The peak of age distribution is between 50 and 60 years of age. Accompanying diseases are obesity, diabetes and hypertension. The endometrial cancer has its precancerous stages. The pertinent estrogenic stimulus is probably significant for the development of precancerous lesions: adenomatous hyperplasia of the endometrium without atypias is known as an optional, that with atypia as an obligatory precancerous lesion. The range of morphologic variation extends from mature endometrial adenocarcinoma with favorable prognosis to immature neoplasias with unfavorable outcome. Besides various other parameters of neoplastic disease the depths of infiltration into the myometrium is known to be significant. The leading sign of endometrial cancer is uterine bleeding. The histological diagnosis is established by the examination of the tissue produced by curettage from the cervical canal and from the uterine cavity. A true early diagnosis--in comparison to the early detection of cervical cancer--does still not exist for endometrial cancer. Exfoliative cytology from the uterine cavity or ultrasonography does still not allow the final and definite diagnosis. Among the therapeutic alternatives abdominal hysterectomy in combination with bilateral adnexectomy plays the most important role. Depending from more specific morphologic criteria of a given case additional pelvic and paraaortic lymphnode-dissection is advised. Surgical therapy in general accounts for a 10 to 20 percent better survival. In patients who cannot surgically be treated because of the local extension of the tumor or due to a general high risk situation the primary therapy is pelvic irradiation both by packing and percutaneously. Disseminated neoplasms, adenocarcinomas in particular, respond well to large dosages of progestins, whereas combinations of cytostatics have failed to show favorable results, perhaps with the exception of those containing adriamycin. All endometrial cancer patients need special posttreatment care, because early recurrences still have a certain chance of survival when recognized and appropriately treated.
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PMID:[Precancerous conditions and cancer of the endometrium]. 269 33

Overall 1,021 patients with endometrial carcinoma were treated between 1965 and 1982 at the Department of Obstetrics and Gynecology and the Department of Radiology, Friedrich-Schiller-University, Jena. The 5-year-survival rate of all patients amounted to 63%. The 5-year-survival probability with primary surgery was 76.1%, with primary irradiation 34.4%. The frequency of risk factors in the patient group was compared with an age adjusted group of patients who underwent a D & C due to irregular bleeding of benign causes. Overweight and infertility were evaluated as significantly more frequent risk factors in cancer patients. There was no significant difference between the two groups concerning the factors hypertension, diabetes, heart-diseases, irregular bleeding and history of carcinoma in the family.
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PMID:[Results of therapy of endometrial carcinoma and analysis of risk factors in comparison with a control group]. 275 77

Due to the increasingly elderly population of the United States, it was elected to review the experience at the Cleveland Clinic Foundation in treating women older than 75 years of age for gynecologic cancer. The charts of 114 patients were reviewed to study the presentation of primary cancers, the morbidity and mortality associated with therapies, and patient survival. Cardiovascular disease, including hypertension, and diabetes mellitus were the most common associated medical problems. 36% of patients had endometrial cancer, 25% cervical cancer, 19% vulvar cancer, 12% ovarian cancer and 7% vaginal cancers. Compared to data for patients of all ages in Annual Report on the Results of Treatment in Gynecologic Cancer (Vol. 18), patients with endometrial, cervical, and vulvar cancers were of a significantly more advanced stage than expected. Therapy was modified due to patient age or medical status in 42 patients. No postoperative mortality was encountered, although patients often required multiple prolonged hospitalizations. The projected overall survival rate (Kaplan-Meier Analysis) was 44% at 5 years. It is concluded that despite their advanced age and associated medical problems, very elderly patients can usually receive definitive cancer therapies, including surgery, after careful preoperative medical evaluation and therapy.
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PMID:Gynecologic cancer in the very elderly. 290 49

The risk of endometrial cancer in relation to nutrition and frequency of consumption of a few selected dietary items was evaluated in a case-control study of 206 patients with endometrial cancer and 206 control subjects with acute conditions unrelated to any of the established or potential risk factors for endometrial cancer. Obesity was strongly and positively associated with the risk of endometrial cancer, and several conditions related to body weight, such as early menarche, diabetes mellitus, or hypertension were more common in cases. The risk of endometrial cancer was elevated in subjects reporting (on a subjective basis) greater fat (butter, margarine, and oil) intake (relative risk estimate for the higher compared to the lower scores equals 5.65, with 95% confidence interval of 2.76-11.55). Cases reported less frequent intake of green vegetables, fruit, and whole-grain foods: thus, the risk of endometrial cancer appeared inversely related to indices of beta-carotene and fiber intake. Furthermore, cases consumed milk, liver and fish less frequently than controls. No significant difference was noted between cases and controls in the frequency of intake of carrots, meat, eggs, ham, and cheese. Alcohol consumption was somewhat larger among the cases, but this trend in risk was not significant. Dietary information collected in this study probably is too limited and inconsistent to permit analysis of biologic correlates of these findings or discussion of their potential implications in terms of prevention on a public health scale. Nonetheless, the mere existence of differences in reported diet between endometrial cancer cases and controls is of interest, and may warrant further, more detailed investigation.
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PMID:Nutrition and diet in the etiology of endometrial cancer. 300

Mechanism of action, indications, side effects and contraindications of oral contraceptive agents (OCA) are reviewed. OCA can be divided into two groups: consecutive and combined agents. Combined OCA contain both estrogens and gestagens and are taken for 3 weeks, while consecutive OCA contain only estrogens and are taken for 2 weeks followed by 1 week of combined OCA until the onset of menstruation. Biological activity of synthetic gestagens is estimated by a dosage which results in a delay of menstruation by 2 weeks. Gestagens norethindrone and norethynodrel were shown to be equally effective, while ethinodiol diacetate and norgestrel were 15-30 times more effective. Estrogen component of OCA is represented by ethinyl estradiol or mestranol. Combined OCA are more effective than consecutive OCA; probability of undesirable pregnancy during administration of combined OCA does not exceed 0.2%. The most frequent side-effects of OCA include nausea, headache, uterine hemorrhage, and changes in libido. OCA can affect the endocrine and reproductive systems. Major endocrine effects of OCA include changes in the cortisol metabolism in the adrenal glands, increase in the level of thyroid-binding globulin in the thyroid gland, changes in the glucose metabolism in the pancreas, inhibition of the luteinizing hormone releasing hormone in the hypothalamus with simultaneous decrease in the production of pituitary gonadotropins and inhibition of the ovulation. The most serious side-effects of OCA include cholelithiasis, thrombophlebitis, thromboembolism, liver adenoma, and myocardial infarction. Absolute contraindications to the use of OCA include hypertension, hyperlipidemia, breast or endometrial cancer, pregnancy, cardio-vascular diseases, liver diseases, and kidney insufficiency.
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PMID:[Principles of the use of oral contraceptive preparations]. 307 80

A case is presented of a healthy, 36-year-old woman with leiomyomas of the uterus to illustrate the broad dimensions of choosing an appropriate contraceptive method. Additionally, this woman had a history of pregnancy-induced hypertension, gestational diabetes, and a family history of breast and endometrial cancer. The woman presented for contraceptive advice 5 days after a regular, normal menstruation. She reported that she generally had been healthy, with no current medical problems and had used several barrier methods of contraception. The woman found the barrier methods to be unreliable as well as somewhat difficult to use. The clinical problem was how best to provide this woman with contraception. The patient was divorced and sexually active, and she wanted to remarry and to have more children. As this patient was parous and had not experienced previous problems with excessive menstrual blood loss or dysmenorrhea, she might have tolerated an IUD well. However, women with leiomyomas, especially the kind that produce an irregular cavity, should not use an IUD. Additionally, IUDs have been linked to an increased incidence of pelvic inflammatory disease, particularly in women with multiple partners. Consideration was given to steroid contraceptives -- oral (OCs), injectable, and implantable -- for this patient. The last 2 modalities were potential options as the patient had no immediate plans for conception. Various aspects of the patient's family history as well as the physical findings needed to be evaluated in relation to the use of hormones. In this context, the familial predisposition to breast cancer was considered. As the results of the Centers for Disease Control and the National Institute of Child Health and Human Development Cancer and Steroid Hormone Study showed no change in risk of breast cancer in OC users, regardless of age at 1st use or subsequent duration of use and other large epidemiologic studies have confirmed these findings, the patient's family history of breast cancer was not a contradindication to OC use. The somewhat remote family history of endometrial carcinoma was not epidemiologically significant. The fact that no adverse effect of high dose contraceptives on existing tumors has surfaced in 2 decades of OC use by millions of women is reassuring. A large body of clinical information concludes that there is no contraindication to prescribing OCs for women with gestational diabetes. Concerns about the cardiovascular effects of OCs stemming from reports in the 1960s and 1970s remain questionable and are not likely to be relevant to contemporary OCs. Injectable medroxyprogesterone, which is remarkably free of adverse reactions, proved or suspected, after 2 decades of use, was chosen as an appropriate contraception option for the patient described.
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PMID:Medical aspects of contraception. 310 32

A matched case-control study was undertaken with the aim of determining the presence of several risk factors for breast and endometrial cancer in a cohort of women--recruited from a defined geographical area of Sweden--who had received at least one oestrogen prescription for menopausal symptoms. A mailed questionnaire was answered by 653 (88.8%) of 735 women sampled from the cohort (cases) and 952 (76.8%) of 1240 women sampled from the background population (controls) and these respondents formed the basis of the analyses. The prevalence rates of oophorectomy and hysterectomy were significantly higher among oestrogen-treated women than in the background population, 10.7% versus 2.6% (odds ratio (OR) = 5.1, 95% confidence interval (Cl) 3.1-8.5) and 19.0% versus 7.3% (OR = 2.7, Cl 1.9-3.8), respectively. Higher theoretical education entailed a more than twofold increase in the risk of receiving oestrogen treatment, compared with women with less than eight years at school. Women who had a first degree relative with breast cancer ran a relative risk of receiving oestrogen therapy of 0.6 (Cl 0.4-0.9) whereas the risk for women with a prior breast biopsy was 1.4 (Cl 1.0-2.1). For all other variables studied, ie diabetes, hypertension, age at menarche, age at first livebirth, nulliparity, age at menopause, height and weight, there were no statistically significant differences between the cohort of oestrogen-treated women and the background population. We conclude that the difference in the prevalence of hysterectomy has to be taken into account when calculating the risk of endometrial cancer in the cohort.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Risk factors for breast and endometrial cancer in a cohort of women treated with menopausal oestrogens. 322 79

Estrogen replacement therapy is effective for the prevention and treatment of postmenopausal osteoporosis and should be offered to all women at high risk for osteoporosis. Such therapy is particularly beneficial for prevention of spinal compression fractures; in addition, it alleviates menopausal symptoms (hot flushes, genitourinary symptoms, and changes in mood). In each patient, these benefits must be weighted against the potential risks of endometrial hyperplasia and carcinoma, breast tenderness, hypertension, vascular headaches, and the inconvenience of menstrual bleeding if the uterus is intact. The risk of endometrial cancer associated with estrogen replacement therapy can be considerably reduced by the addition of a progestin, and other side effects can be diminished or eliminated by use of the new transdermal estrogen preparations. Thus, estrogen replacement therapy should be considered in all women who have experienced natural or surgically induced menopause, and it is advisable in women who have osteoporosis or an increased risk for this disorder and no contra-indications to its use. Estrogen replacement therapy should be instituted as soon after menopause as possible and seems to be well tolerated until at least 75 years of age.
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PMID:Estrogen replacement therapy: current recommendations. 328 71

Epidemiological studies of oral contraceptives pertaining to premenopausal women are briefly reviewed. Therapeutic considerations are noted. The clinical effects of aging and hormone replacement therapy are indicated in terms of metabolism, the endometrium, and bone mass. The pharmacological advantages and consequences of nonhormonal and hormonal contraception are explored. For aging women over 40, there is a need for relief of menopausal symptoms, contraception, and reduction of risks for atherosclerosis, hypertension, coronary heart disease, endometrial carcinoma, breast cancer, and osteoporosis. With the availability and use of low estrogen products, women over 40 can insure tissue support and prevent bone loss as long as the therapy is instituted within 3 years of the last menses. Over-40 women who drink and smoke should not use oral contraceptives. Sterilization does not satisfy longterm hormonal needs, and has other reported menstrual side effects. The dose and duration regimen of hormonal therapy must be carefully considered due to the effects on the endometrium., the coagulation system, the liver, lipids, and bone. Combination estrogen and progestogen is necessary, but consideration must be given to existing levels of endogenous hormones. Lipid patterns may change due to hormone replacement or as a result of aging and contribute to coronary heart disease. Hormone replacement can reverse the atherogenic pattern of increased low density lipoprotein levels and decreased high density lipoprotein levels; a chart gives the effects on lipids and coagulation from various estrogen or estrogen plus progestogen products. For the estrogen-deficient menopausal woman, high estrogen can decrease antithrombin III plasminogen and alpha-antitrypsin antigen levels. Lower dose progestogens are recommended. Studies of dose and effects on bone mass are reviewed and vaginal rings and transdermal steroid patches, triphasic formulations, and new progestational agents such as 19-nortestosterone derivatives are described. Newer low dose formulations are needed for the aging woman, as well as further research on what product best suits the variability of women aged 40-50
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PMID:Contraception for the perimenopausal patient. 330 20

Adverse and beneficial effects, especially with regard to mortality rates, of oral contraceptives (OC) are reviewed. In 1980 approximately 80 million women used OCs worldwide. OCs were first marketed in the United States in the 1960's, but by the 1980's low-dose combination pills with less estrogen and progesterone content became widespread along with the minipill, injectable preparations depo- medroxyprogesterone DMPA, and norethindrone containing capsules. Relative disease risk estimates are based on cohort studies and case- control studies. The Royal College of General Practitioners RCGP Oral Contraceptive Study of 1974 involved 46,000 women aged over 15 (50% were OC users, 50% were nonusers) the Oxford Family Planning Association Contraceptive Study of 1976 recruited 17,032 women aged 25-39, 56% of whom used OCs, and the Walnut Creek Contraceptive Drug Study of 1981 studied 16,638 women aged 18-54 of whom 28% were OC users and 33% were former users. A somewhat elevated mortality among ever-users of OCs in the order of 20% seems to be indicated by these studies mostly attributable to diseases of the circulatory system. Current OC use is also a risk factor in thrombotic stroke of the order of 4 or 5, but former use of OCs lowers the risk to 2. The effect of OC dose and formulation, duration of use, and predisposing factors on hemorrhagic and thrombotic stroke appears to be inconclusive with varying data from different studies. There is evidence for some increase in ischemic heart disease among current OC users, and also a 2-fold increase of myocardial infarction (MI) when smoking, serum cholesterol, and hypertension is taken into account, moreover higher estrogen dosage also contributes to a higher incidence of MI. There is also a 5-fold increase of venous thromboembolism among OC users induced by duration of use and estrogen potency, as OCs seem to promote atherogenesis, although the roles of progesterone and estrogen are conflicting. combination pills reduce the rate of endometrial cancer, provided protection against ovarian cancer, and do not seem to increase breast cancer incidence, although the relative risk of cervical cancer is elevated. Mortality risks with older OCs outweigh the benefits.
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PMID:On the epidemiology of oral contraceptives and disease. 331 96


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