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

Since Gusberg's description in 1947 of adenomatous hyperplasia (15), the role of precursors in the development of endometrial carcinoma has been well studied. There is now no doubt that in many patients histologic precursors can be demonstrated in the endometrial cavity prior to the development of invasive cancer. At this point in the continuum, interruption by hysterectomy or other therapy will insure the patient's health. We have discussed a wide variety of techniques designed to provide cytologic or histologic samples of the endometrium that are highly effective in the detection of early neoplasia. As a goal, universal endometrial sampling on a periodic basis is probably impractical and may be unecessary or undesirable. However, surely the patient at high risk for endometrial cancer requires close periodic screening. The high-risk category may be expanded to include others beyond the group of hypertensive, diabetic, obese, anovulatory, nulliparous women. It should include patients with irregular vaginal bleeding, those with a strong family history of genital and breast cancer, those patients receiving hormone therapy, and patients in the menopausal years who experience changes in the menstrual pattern. With intelligent and aggressive application of outpatient screening, uterine cancer can be diagnosed when patients are virtually completely curable, thus resulting in further reduction in mortality from this disease.
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PMID:Screening for endometrial cancer. 76 37

It is the committee's opinion that estrogens may become a promotional agent in the development of endometrial cancer in a small percentage of patients receiving estrogens. Since it appears that within the next few years 50% of all women by the age of 50 will have had a hysterectomy, and the disease occurs at an average age of 60 years, many women will have been removed from risk and few women's years of life may be lost. The risk is further reduced by the fact that early discovery of cancer of the endometrium has a cure rate of approximately 95%. Physicians administering estrogens should observe their patients carefully and perform curettage promptly for abnormal bleeding. More sophisticated methods of assessing the postmenopausal uterus are needed. Although the risk of estrogen users developing cancer of the breast has not been conclusively determined, patients with areas of thickening and nodularities in the breast should not receive estrogens. Women with sizable cysts should not receive any estrogenic hormone, and special consideration should be given in cases with close family histories of breast cancer. The most important factors are careful physical examination made by the patient and her physician at intervals of 6 months to 1 year and mammography when indicated.
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PMID:Do estrogens cause cancer? 84 91

The use of estrogen during the climacterium is discussed. Estrogen should be used only when objective symptoms of a lack of estrogen can be established. Thrombosis, hypertension, breast cancer, uterine cancer and ruptured blood vessels are contraindications to climacteric estrogen use. Progestagens administered in conjunction with sedatives and diuretics can often relieve climacteric afflictions. Continued administration of estrogen should be avoided; estrogen can be administered with or without gestagens 7-10 days before menstruation or in 21-day periods. General practitioners are qualified to administer estrogen and should give patients regular examinations. There is a risk of developing endometrial cancer under climacteric estrogen treatment. Only women who want and need climacteric estrogen treatment should receive it.
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PMID:[Estrogen treatment only when symptoms are present but complaints should not be neglected]. 86 7

Antiestrogens, e.g., nafoxidine, tamoxifen, and clomiphene, have been reported to induce objective clinical remissions in patients with breast cancer. Review of data indicates activity of these agents in renal and prostate cancer. In a trial of nafoxidine in 20 patients with adenocarcinoma of the kidney, 2 complete and 1 partial regressions were observed. Stabilization of the disease for 3 months was noted in 5 patients. In another trial, 2 of 4 patients with renal cancer responded to tamoxifen. Similar experiences have been recorded in endometrial cancer with clomiphene. In patients with prostatic cancer, responses have been reported in 1 of 2 patients receiving nafoxidine and in 2 of 4 receiving tamoxifen. These preliminary clinical data should encourage trial of antiestrogens in malignancies other than breast cancer. Estrogen receptor studies may help identify patients most likely to benefit. These agents have a relative lack of toxicity.
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PMID:Letter: Antiestrogens in the treatment of cancer. 93 94

The published data for overall cancer incidence for the registries of Birmingham (UK) and Connecticut (US) show remarkable similarity for men but diverge for women. The incidence of cancer of the endometrium, ovary and breast in Connecticut is higher than in Birmingham, and in each case the menopausal dislocation in the age-specific incidence plot of the Birmingham data is obscured in that for Connecticut. For endometrial cancer, the difference correlates with differences in the two countries in the use of oestrogen replacement therapy, recently implicated in the aetiology of endometrial cancer. The similarity in the pattern for ovarian and breast cancer, and the changing pattern of breast cancer incidence in Birmingham suggest a similar aetiological effect.
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PMID:Age-specific incidence of cancer of the endometrium, ovary and breast in the United Kingdom and the United States. 99 30

The problem of a relationship between nutrition and cancer has to be approached from two different points of view: 1. Direct effect of carcinogens present in foods or in food additives (direct carcinogenesis), 2. In-vivo synthesis of carcinogens caused by changes in metabolism due to altered dietary habits (indirect carcinogenesis). For the second mechanism, we have to make a distinction between the effects of nutritional deficiency and of nutritional excess. Some examples from animal experiments are presented. In man, possible relationships between nutrition and cancer are postulated mainly for tumors of the gastrointestinal tract and recently also for hormone-dependent cancers. Epidemiological evidence points to the major importance of the indirect way of carcinogenesis caused by specific nutritional deficiencies and excesses. Experimental studies in man are difficult to perform. Therefore, most hypotheses are based on statistical associations, and great caution is required in drawing inferences on causal relationships. Cancers of the upper and lower gastrointestinal tract epidemiologically behave in a different way, the former showing a marked decrease in most western countries, the latter a slight increase. The etiology of the cancers of the esophagus and stomach has still to be determined in spite of many hypotheses. Migrant studies show a major effect of environmental rather than genetic factors. Substantial differences in dietary habits between countries with high and low incidence of stomach cancer (Japan and United States) point to the importance of nutrition as an etiological factor with a high probability, but no specific dietary components have been identified so far. The same is true for cancer of the large bowel. Recent hypotheses suggest that dietary factors may relate to cancer of the colon by their effect on bile production and on the bacterial makeup of faeces which in turn might be transforming bile acids into active carcinogens. There is, however, disagreement about the specific dietary component responsible for this model of carcinogenesis. BURKITT stresses the importance of the lower consumption of dietary fiber, resulting in retarded bowel function and additional time for bacterial proliferation and degradation by bacteria of bile acids. WYNDER, on the other hand, explains the increased bile acid and neutral sterol excretion and microbial modification of these compounds with the high content of animal fat in the western diet. With hormone-dependent cancers (breast, endometrium, ovary, prostate), a correlation has been shown between body weight and height and breast cancer as well as between overweight and cancer of the endometrium. Which aspect of diet, if any, is responsible for changes in hormone metabolism, resulting in an increased risk of these cancers, is still to be proved. On the basis of current knowledge, it is extremely difficult to draw inferences for preventive action. Certainly, a cancer-preventing diet cannot be established...
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PMID:[Nutrition and cancer (author's transl)]. 101 38

The use of estrogens almost tripled during the 1965-75 period, with usage concentrated as a cure-all for aging, for the degenerative diseases associated with aging, and for the emotional difficulties of middle age. 3 separate studies published in the last year have shown a high level of association between estrogen use and the development of endometrial cancer. Results of these studies coupled with the significant recent increase in the incidence of cancer in women over 50 who are in the high socioeconomic groups--the groups most likely to use estrogen therapy--emphasize the association. The U.S. FDA has proposed a modification in the labeling for estrogens, and a package insert for patients which would warn of possible hazards of estrogen therapy. It is recommended that estrogen be used only for vasomotor symptoms and vaginal atrophy. The lowest possible effective dosage should be used and for the shortest possible amount of time. Earlier studies had suggested that estrogen replacement therapy might protect against breast cancer; most recent studies suggest the opposite. In addition, estrogen may trigger high blood pressure and increase some blood clotting. Women with high blood pressure or a family history of early heart attacks are contraindicated from using estrogen therapy. Even for the treatment of osteoporosis, there may be safer alternative therapies. Women are cautioned as to their own responsibilities when taking estrogens.
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PMID:Estrogen therapy: the dangerous road to Shangri-La. 102 54

Twenty cases of endometrial carcinoma are reported, observed in women who had received long term tamoxifen treatment as adjuvant therapy for breast cancer. Furthermore, a specific study was carried out on an homogeneous group of 790 women with an operable breast cancer, 318 receiving tamoxifen as adjuvant treatment. Five endometrium carcinoma were observed in the group under tamoxifen versus none in the other group. From an analysis of these cases, authors will carry out a case control study to evaluate the relative risk of endometrial carcinoma for patients under tamoxifen. They underline the importance of gynecologic follow up procedures for all women receiving this endocrine therapy.
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PMID:[Adjuvant therapy of breast cancer with tamoxifen and endometrial carcinoma]. 129 64

Research and development in contraception has only limited interest in women over 35 years old, so we know little about safety, side effects, and effectiveness of contraceptives in this age group. In addition, clinical trials use healthy women which further limits our knowledge about contraceptives in women who have cardiovascular problems, diabetes, and liver conditions. Research does indicate, however, that women with high blood pressure should not take oral contraceptives (OCs) after the age of 35. It also shows that healthy and nonobese women over 35 who do not smoke and have no family history of cardiovascular disease before age 45 can take OCs with 30 mcg of ethinyl estradiol. Practitioners should provide these women with balanced and up-to-date information on the link between OCs and breast cancer and their apparent protective effect against endometrial cancer. The pregnancy rate for 35-39 year old married women using the diaphragm for at least 5 months stands at 1.1/100 women years. Contrary to popular belief, barrier methods can be harmful, e.g., urinary tract infections are more frequent in women who use the diaphragm than in those who do not. Women older than 35 should consider the condom because of its ability to reduce the risk of acquiring HIV or sexually transmitted diseases. Considerable research exists on women over 35 who use copper releasing IUDs. These IUDs are safe in women who do not have heavy menstrual bleeding. The levonorgestrel releasing IUDs are well tolerated in women over 35 since they reduce the amount and duration of menstrual bleeding. Besides users of these IUDs are less likely to have pelvic inflammatory disease and endometritis than those using copper releasing IUDs. Older women in developing countries often undergo hysterectomy for contraceptive purposes and because of heavy bleeding. Tubal ligation is a significant family planning method for older women in developing countries.
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PMID:Contraception after thirty-five. 131 37

This paper presents results, 5 years after closure, of a randomized trial comparing adjuvant with postrelapse tamoxifen in 747 women with histological node-negative breast cancer. Two hundred thirty-six disease-free patients on adjuvant therapy were secondarily randomly assigned at 5 years to stop or to continue tamoxifen until relapse. Adjuvant tamoxifen, taken for a median duration of 60 months, has significantly prolonged disease-free survival overall (P = .0001), in the 214 premenopausal group (P = .018), in the 533 postmenopausal group (P = .0026), and for the 246 patients with estrogen receptor levels greater than 19 fmol/mg of protein (P = .0032); distant relapse has also been delayed overall (P = .029). Total survival comparison by Kaplan-Meier life-table analysis shows a nonsignificant trend in the same direction (P = .07). Adjuvant tamoxifen has also reduced the incidence of contralateral breast cancer and of death from myocardial infarction. No increase in the incidence of endometrial cancer has been found.
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PMID:The Scottish trial of adjuvant tamoxifen in node-negative breast cancer. Scottish Cancer Trials Breast Group. 132 Sep 20


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