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Query: UMLS:C0476089 (endometrial cancer)
 11,379 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A relationship between exposure to exogenous estrogens and endometrial carcinoma has been reported in numerous studies. The incidence among those so exposed has been estimated to have been increased from 7.5 to 8 times that of those not exposed. Long-term therapy with estrogens for menopausal symptoms has been the usual history. Breast cancer patients treated with estrogens and young women taking sequential oral contraceptives have had increased risks. In this study, the records of Olmsted County, Minnesota, residents with endometrial uterine cancer diagnosed between 1945-1974 at the Mayo Clinic or at other medical facilities were reviewed. There were 122 adenocarcinomas and 23 adenoacanthomas. In 3 instances, adenocarcinomas contained zones of uterine sarcoma. For each of the 146 patients there were 4 age-matched controls. Estrogen use for 6 months or more was recorded for 39 (27%) of the 145 cases and for 163 (28%) of the 580 controls. The controls had more frequent histories of short-term estrogen therapy. Cancer patients had relatively more estrogen use for menopausal symptoms. The relative risk of endometrial cancer tended to increase with the duration of exposure to conjugated estrogens from 2.0 with any exposure to 4.9 (p less than .01) after 6 months or more and to 7.9 after 3 years or more. The risk increased with larger doses (1.25 mg or more) and with continuous administration of conjugated estrogen. Myometrial invasion was superficial in 77 cases and deep in 44 cases. Long-term use of conjugated estrogen was frequently associated with low-stage low-grade superficially invasive endometrial malignancy. The 5-year survival rate of the 145 patients was 85%. Patients with Stage 1 had a 95% relative 5-year survival rate. Those with Stages 2, 3, or 4 had 50% survival rates. Of other risk factors, obesity and nulliparity were noted. Patients had more frequent records of benign cystic adenoma and of adenomatous hyperplasia than controls. The corrected age-specific rate for endometiral cancer increased to a maximum of about 90/100,000 population per year in the group aged 55-64 and then diminished with age. An increase in endometrial cancer among those at risk may have been nullified by an increase in those who have had a hysterectomy. In this study the incidence of endometrial carcinoma in Olmsted County does not show an increase in the last 3 decades. It is noted that the long-term use of conjugated estrogens in this area has been relatively low.
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PMID:Exogenous estrogen and endometrial carcinoma: case-control and incidence study. 19 Aug 87

An overview of the risk of developing cancer related to oral contraceptive (o.c.) use is presented. A committee of experts affiliated with WHO studied the problem of developing cancer related to o.c. use. O.c. use for more than 2 years prevents the formation of benign breast tumors, even after discontinuing o.c. use. The effect is due to the progestin component. There is no clear indication that o.c. use increases the risk of breast cancer. A higher risk of endometrial cancer is associated with sequential preparation use, but not with the use of combination preparations. Cervical neoplasms and pituitary adenoma may be more frequent among predisposed women who use o.c.s. Studies show a reduced risk of ovarian cancer with o.c. use, but more studies are necessary. There is a marked increase in the relative risk of developing hepatocellular adenoma among women who use o.c.s for longer than 3 years. The risk increases with the hormone dosage, the duration of treatment, and the age of the patient. There is no reliable data to indicate that the risk of malignant melanoma increases with o.c. use. More study is needed to determine the possible cancer risks of injection preparations. Combination preparations can cause an increased risk of vaginal epithelial metaplasia. Diethylstilbestrol taken during early pregnancy can cause vaginal neoplasms in the offspring. More epidemiological studies and clinical and laboratory studies on the carcinogenic effects of o.c.s and the endocrinological effects of o.c.s on younger women should be undertaken. It is recommended that o.c.s with the lowest possible hormone dosages be used. O.c.s should not be prescribed to women with vaginal adenosis.
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PMID:[Oral contraceptives and the risk of neoplasms]. 44 57

Contrast media in magnetic resonance imaging (MRI) of the abdomen and pelvis are applied for various purposes; different substances and forms of application must be distinguished. Oral contrast agents are primarily used to enhance the discrimination of the intestine from the other organs and from pathological lesions. Clinical studies of i.v. contrast agents focus on two substances: gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA) and superparamagnetic iron oxide. Whereas dynamic Gd-DTPA-enhanced MRI improves the differential diagnosis of focal hepatic lesions, iron oxide is a promising agent for increasing the sensitivity of MRI in the detection of hepatic and splenic tumors. Dynamic Gd-DTPA-enhanced MRI of the kidney allows functional assessment of this organ; good demarcation of kidney tumors is only achieved during the early phase of a dynamic examination. In the assessment of adrenal lesions, dynamic Gd-DTPA-enhanced MRI permits better differentiation of adenoma from malignancy. Intravenous Gd-DTPA also appears to be useful in the staging of urinary bladder tumors to distinguish between superficial and infiltrating tumors. Although offering no major diagnostic advantage in the staging of cervical carcinomas, Gd-DTPA-enhanced MRI improves the discrimination of necrotic tumor portions of endometrial carcinoma and allows good differentiation of this lesion from fluid retained in the uterine cavity. Studies of new contrast agents for MRI of the abdomen, which have so far only been investigated in animal experiments, focus on liver imaging. These substance include hepatobiliary agents, Gd-DTPA-containing liposomes, and paramagnetic macromolecules.
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PMID:Contrast-enhanced magnetic resonance imaging of the abdomen and pelvis. 220 22

Twenty-four patients with pelvic disease were examined using a resistive magnet operating at a field strength of 0.15 T. and a R.F. frequency of 6.36 MHz. Spin-echo, multiecho (TR = 0.5-2 s; TE = 50-100 ms) and Inversion Recovery techniques (TR = 1.4 s; TI = 0.4 s) were employed. The proliferative processes of the pelvic organs were subdivided into: prostate (adenoma 5 cases, carcinoma 5); bladder (carcinoma 3, lymphoma 1); uterus (fibroma 1, cervical carcinoma 6, endometrial carcinoma 3). All patients were evaluated with conventional methods and had histological diagnosis. The little respiratory motion of pelvic organs allowed to obtain good coronal, sagittal and axial images. The main aspects of normal anatomy and pathology are analized and described. The tissue characterization of normal structures provides good anatomic details; multiplanar images depict the extent of the lesions properly. N.M.R. is an interesting method in evaluating the extension of pelvic masses and staging pelvic tumors.
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PMID:[Initial experiences in the study of the pelvis using nuclear magnetic resonance imaging with 6.36 MHz radiofrequency]. 241 Sep 56

The objectives of this article on epidemiological studies of health risks from oral contraceptives (OCs) is to review major studies of the association between OCs and circulatory disease and cancer. It is also to emphasize methodologic limitations of the existing data, and to identify unresolved and important questions. A brief discourse on the nature and imputation of relative risk is provided. Cardiovascular diseases covered include ischemic heart disease, stroke, and thromboembolism. Current studies on low dose pills from 3 large US populations reveal that there is no impact of death from use of OCs. A Great Britain and the Walnut Creek study from the US found a slight but not statistically significant increase in ischemic heart disease. These studies also found a statistically significant 3-fold increase in stroke among OC users and, from another study, a 2-fold increase. These studies were based on high levels of ethinyl estradiol where the risk becomes apparent. The risk for idiopathic venous thromboembolism was 3- 8 fold for current OC users. The accuracy of these findings is questioned when the data reflect such heterogeneity. Cancer is differentiated as breast cancer, endometrial cancer, ovarian cancer, cervical cancer, malignant melanoma, and hepatocellular adenoma. For breast cancer, both case control studies as well as cohort studies found no increase in breast cancer. Future additional research will continue to explore unanswered questions about this association. Beneficial effects of OCs occur for endometrial cancer for as long as 15 years after taking the pill. Only 1 year's use resulted in a 50% reduction in risk of endometrial cancer regardless of pill dose and particularly for nulliparous women, who have an increased risk. The longer duration of use of the OCs results in a protective effect against ovarian cancer, i.e., 5 years of use yields as relative risk of below 0.5 and the results of a protective effect can be seen as early as 3 months after pill use. There is about 40% protection against ovarian cancer even with low dose pills; the effect lasts 15 years after cessation of OC use. Cervical cancer studies have shown mixed results. The human papilloma viruses 16 and 18 have been shown to be related to cervical cancer but further research is needed to identify the association with OCs. Data are inconclusive but lean in the direction of no association with malignant melanoma. Hepatocellular adenoma has not been identified in large vital statistics studies, although several small studies have suggested an increased risk. It has been shown by Fortney et al. that with a 50% increase in cervical cancer risk and a 3-4 fold increase in cardiovascular disease risk that OC use for 5 years before the age of 30 years adds 4 days to a health women's life.
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PMID:Results of oral contraceptive epidemiologic studies regarding neoplastic and cardiovascular effects. 257 54

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

Cancer is the presumed complication of oral contraceptive (OC) use that is of greatest concern to the public, although with the exception of cancer of the endometrium, which was linked to 1 specific type of sequential preparation, Oracon, there is no convincing evidence linking OCs and cancer. Oracon was found in detailed study to be strongly associated with subsequent risk for cancer, while other sequentials and combination pills were found to reduce the risks. Oracon was different from other sequentials in that it contained a large amount of estrogen, 100 mcg of ethinyl estradiol, with only a weak progestin, 25 mg of dimethisterone, too little to reverse estrogen-induced endometrial hyperplasia. Proctection appears to increase with duration of use of combined OCs. The Centers for Disease Control (CDC) estimates that approximately 2000 cases of endometrial cancer are prevented each year in the US due to the present level of OC use. Evidence is strong that OCs are a means of preventing ovarian cancer, the 4th leading cause of cancer deaths among women in the US. Case-control studies show that women with ovarian cancer are less likely to have used OCs than are controls without cancer. Physiologically, the risk for cancer of the ovary seems to be related to what has been described as "incessant ovulation". Until recently, most women throughout history have been either pregnant or lactating for most of the time. Time spent pregnant or on OCs, with resulting blockage of ovulation, is now established as protective against ovarian cancer. The longer a women has been taking OCs, the greater the protection. Researchers at the CDC estimate that 1700 ovarian cancer deaths are prevented each year in the US by the use of OCs. Results of epidemiologic studies exploring the connection between OC use and cervical cancer are incolclusive because of methodological problems of preventing bias and controlling for confounding variables. Women taking OCs are more likely to have regular cervical cytology, giving rise to selection bias. Use of women emloying barrier contraception as a control group is another source of bias because barrier contraceptives reduce the rise of cervical neoplasia. Sexual behavior, especially age at onset of sexual activity and number of partners over time, is an important determinant of cervical cancer risk and therefore an inportant confounder that is difficult to control. On balance, there appears to be no or very little increased risk of cervical cancer from OC use; given the confounding factors, a final answer may never be obtained. The risk of developing hepatocellular adenoma is about 30 cases/million women per year.
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PMID:Oral contraceptives and neoplasia. 648 5

Recent cohort and case control studies of low-dose combined oral contraceptives (COCs) containing the new generation of progestogens have allowed classification of adverse effects into those which are rare but serious and should be considered risks and those which are more frequent but are less of a threat to health. Low-dose COCs continue to affect coagulation in a complex way, but the risk is less than with the older preparations, and it can be minimized by screening women for a personal or familial history of early or unusual thrombosis and for levels of protein C, S, and antithrombin III. Women with true migraine with focal signs should also avoid using COCs. The relative risk of myocardial infarction (MI) may increase from 4:1 in women with one risk factor (age, smoking, hypertension, hyperlipidemia, and diabetes) to 20:1 with two risk factors and 128:1 with three or more risk factors. In the absence of all risk factors, a recent study indicated that the relative risk of MI with COC use was 1.9 for current and past use. COC use also causes a slight increase in hypertension in most women, especially those who are older or have a family history of hypertension. While the COC can affect carbohydrate and lipid metabolism, the new generation of progestogens has reduced these effects. The COC may accelerate presentation of gallbladder disease in predisposed women. The COC protects against benign breast disease but may increase the risk of breast cancer and cervical cancer slightly. There is a strong link between hepatocellular adenoma and COC use, but the incidence is low. Return to fertility after use has not been a problem. Both estrogenic adverse effects (nausea, dizziness, irritability, weight gain, bloating) and progestogenic adverse effects (vaginal dryness, acne, hirsutism, weight gain, depression, loss of libido) can occur in 50% of women, but these generally disappear after a few months of use. In conclusion, the low-dose, third generation COCs are associated with minimal risks in the absence of other risk factors and have many beneficial effects such as the prevention of ovarian and endometrial cancer; a decrease in pelvic inflammatory disease and ectopic pregnancies; and protection from anemia, primary dysmenorrhea, functional ovarian cysts, and benign breast disease as well as from the morbidity and mortality associated with pregnancy.
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PMID:The combined oral contraceptive. Risks and adverse effects in perspective. 776 40

A human monoclonal antibody, YJ-37 (IgM) was generated through the fusion of human B lymphoblastoid cell line HO-323 with the regional lymph node lymphocytes from a colonic cancer patient who was treated with a local immunotherapy. This antibody was purified and conjugated with biotin, after which direct immunohistochemical staining was performed. The results revealed that YJ-37 selectively reacted with colonic cancer (7/19), gastric cancer (3/6), endometrial cancer (1/2) and colonic adenoma (7/13), but not with normal epithelia. Membrane immunofluorescence and FACS analysis also showed that YJ-37 bound to tumor cell surfaces. Furthermore, the chemical structure of the antigen defined by YJ-37 was analyzed by means of thin-layer chromatography immunostaining and ELISA. The results indicated that YJ-37 reacted with sialylated lacto-series carbohydrate chains, which have been reported to accumulate in cancer cells.
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PMID:A cancer-reactive human monoclonal antibody derived from a colonic cancer patient treated with local immunotherapy. 844 30

The prognostic significance of a diffusely infiltrative intramyometrial growth pattern was evaluated in 110 cases of low-stage (stages I and II) endometrial adenocarcinoma. Fifty cases were associated with diffuse infiltration (DI group), and 50 cases had more conventional granulation tissue type intramyometrial infiltration (GTT group). Ten cases with carcinomatous involvement of deeply situated adenomyosis (ADMY group) were also studied. The diffusely infiltrative "adenoma malignum" growth pattern featured typically round, regular individual glands, clearly within myometrium but with minimal or absent stromal or inflammatory cell response. Myoinvasion of the conventional sort was characterized by irregular, sharply angulated abnormal glands within myometrium without interposed normal glands or endometrial stroma. The abnormal glands were surrounded, at least focally, by edematous stroma with granulation tissue type reaction and/or an inflammatory cell infiltrate. Mean follow-up was 77.8 months (range 3-219 months) for the patients with diffusely infiltrative myoinvasion and deep adenomyosis and 86.9 months (range 1-206 months) for the patients with conventional myoinvasion. Recurrence-free survival for patients with stage I disease and conventional myoinvasion (94%) was similar to that of patients with diffuse adenoma malignum infiltration (98%; p = 0.13). Survival rates for both groups were also similar. Two (4%) of the 50 patients with diffusely infiltrative adenoma malignum pattern of myoinvasion died of endometrial carcinoma 36 and 72 months after hysterectomy, and 2 (4%) of the 50 patients with conventional myoinvasion died 34 and 67 months after hysterectomy (p = 0.41). Survival in these patients correlated with depth of myometrial invasion and stage. There were no recurrences in the patients with deep adenomyosis. These results suggest that although endometrial carcinomas with diffuse myometrial infiltration are fully capable of aggressive clinical behavior, they do not appear to behave any more aggressively than those with conventional myometrial invasion. Prognostic indicators of clinically aggressive disease are similar to those that have been previously identified for endometrial carcinomas with the more conventional pattern of myometrial infiltration. They include cervical involvement, deep myometrial invasion, higher histologic grade, and lymph-vascular space invasion. Endometrial carcinomas with extensive involvement of adenomyosis and adjacent foci of minimal myometrial infiltration appear to have very low malignant potential, but the number of cases with this finding and adequate clinical follow-up is limited. This finding needs to be confirmed in a much larger series of cases.
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PMID:Diffusely infiltrative endometrial adenocarcinoma: an adenoma malignum pattern of myoinvasion. 988 5


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