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

Estrogen has been used to induce a wide variety of tumors in various animal species but only the rabbit is reported to reliably develop endometrial carcinoma. Variables associated in humans with an increase susceptibility to endometrial adenocarcinoma include aging, obesity, liver diseases, polycystic ovary disease, and ovarian tumors. In women estrogen induces mitotic activity in the endometrium and promotes the proliferation of the endometrium. Current concern that estrogen replacement therapy in postmenopausal women may be associated with increased risk of endometrial adenocarcinoma is based on: 1) reports of increased incidence of the disease, and 2) epidemiologic studies associating estrogen administration with an increased risk of endometrial carcinoma. The author draws the following conclusions based on the existing data: 1) there is likely a small but significant increase in the risk of development of endometrial adenocarcinoma among menopausal women on estrogen replacement therapy; 2) the increase in risk appears to be greatest for women who do not have any of the constitutional stigmas that would ordinarily place them at higher risk for adenocarcinoma; 3) risk increases with increasing duration of therapy, probably following a latent period of undetermined duration; 4) risk increases with increasing dose of estrogen; 5) progestin administration likely affords some protection against the risk, but the potential risks of administering the hormonal equivalent of a combination oral contraceptive periodically to elderly women have yet to be examined carefully; and 6) careful surveillance of patient populations on estrogen replacement therapy may limit the risk of adenocarcinoma associated with estrogens to early, highly curable lesions. It is incorrect to assume that estrogen actually causes carcinoma of the endometrium; it more likely induces a precancerous hyperplastic state in a dose-related fashion and only certain individuals ultimately develop invasive carcinoma.
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PMID:Does estrogen cause adenocarcinoma of the endometrium? 701 37

Adenocarcinoma of the endometrium in patients 40 years of age or younger is rare and accounts for 2.9% of all endometrial cancers diagnosed in the study community. However, the diagnosis of malignancy was confirmed in only 32 of 54 patients (59.2%) with pathologic material available for review. None of the 32 patients had Stein-Leventhal syndrome or was receiving sequential oral contraceptives. Obesity was found in only 37.5%, nulligravidity in 37.5%, and hypertension in 25%. In 81%, the presenting symptom was abnormal vaginal bleeding, and 6 patients (19%) had coexisting ovarian neoplasms (4 endometrioid carcinomas, 1 mucinous cystadenocarcinoma, and 1 adenocarcinoma arising in a cystic teratoma). Atypical endometrial hyperplasia, previously interpreted as well-differentiated adenocarcinoma, was diagnosed in 11 of 22 patients. The pathologic criteria for establishing a diagnosis of atypical endometrial hyperplasia and distinguishing it from well differentiated adenocarcinoma of the endometrium are emphasized. Thirteen of 32 patients received no radiation therapy and none developed pelvic recurrence or metastatic tumor. The 2 deaths from tumor were in patients with stage 3 ovarian cancer, and no patients died of endometrial carcinoma. The current policy is to treat patients with atypical endometrial hyperplasia and well-differentiated adenocarcinoma (clinical stage I, pathology confirmed) by hysterectomy without irradiation treatment. Because of 6 of the 32 patients (19%) had coexisting ovarian neoplasms, careful examination of the adnexa at the time of clinical staging is emphasized.
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PMID:Endometrial carcinoma in women 40 years of age or younger. 701 3

Cases of endometrial carcinoma reviewed for this study were divided into two groups: 1) Premenopausal, perimenopausal and postmenopausal patients in whom a history of anovulation, obesity, ovarian hyperthecosis (including Stein-Leventhal syndrome) or feminizing tumors, and/or exogenous estrogen intake were found; and 2) post menopausal, elderly patients, without known hormonal or metabolic disturbances and without any history of estrogen therapy. In the first group, frequent associated findings were precursor stages of endometrial carcinoma, such as adenomatous and atypical hyperplasia. In the majority of cases, the cancer was confined to the endometrium, rarely infiltrating the myometrium. In the second group, the cancer was associated most often with an inactive, atrophic endometrium and frequently diffusely infiltrated through the myometrium, with lymphatic and vascular involvement. The lymphatic and plasma-cell infiltrate was evaluated in both groups. It was found to be more abundant in the first group, but at the tumor-host interface and perivascularly, than in the second. As reported in other malignancies of the female reproductive system, the presence or absence of a lymphocytic infiltrate as a morphological expression of local cellular immune response of the host correlates well with the biological behavior of the tumor. A challenging question is the relationship, if any, between hormonal factors and immune mechanisms in tumors arising in tissues such as the endometrium that, even normally, are targets of hormonal stimulation.
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PMID:Morphologic correlates of host response in endometrial carcinoma. 709 92

A better understanding of the polycystic ovary syndrome (POS) may help to institute a more rational treatment adapted to each individual case. Seven therapeutic methods have been used until now, progestogens constituting the minimal treatment. Combined oestrogen and progestogen therapy remains basic as long as pregnancy is not desired and should include an anti-androgenic progestogen if hirsutism is to be reduced. Anti-oestrogens have dramatically improved the treatment of sterility and could be used against POS with certain precautions. Parenteral gonadotropins of the HMG variety are usually contra-indicated. Ovarian wedge resection has few indications in view of the risk of post-operative adhesions. Dexamethasone has restored ovulation in some cases. Bromocriptine has recently given promising results. The indications of these various treatments depend on the results to be achieved: endometrial carcinoma must always be prevented, regular menstrual cycles should often be re-established, hirsutism must be avoided or reduced, and fertility should be restored or at least preserved for the future by breaking the hormonal vicious circle. The high incidence of obesity and a possible desire for contraception should also be taken into account.
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PMID:[Treatment of the polycystic ovary syndrome (author's transl)]. 725 38

Irregular menstrual cycles are common in young adolescent females. Some young women suffer from hyperandrogenemia, which results in acne, increased body hair, and increased body weight. If left untreated, severe hirsutism and polycystic ovary might ensue. This paper reviews literature on the usefulness of oral contraceptives (OCs) in treating hyperandrogenemic adolescent women. In these adolescent women, serum luteinizing hormone (LH) and testosterone (T) levels are significantly higher than in sexually mature women. In adolescent women with a menstrual cycle lasting more than 37 days, the serum concentration of pituitary gonadotropins and sex hormones was significantly higher than in adolescent women with normal-length (26-32 days) cycles. Multi-microcystic ovaries have been found in 35% of adolescent women with normal cycles, in 57.9% of women with irregular menstruation, and in 84.6% of women with amenorrhea. These polycystic ovaries were thought to be at increased risk of developing infertility and endometrial cancer. Treatment with low-dose OCs containing progestin had fewer androgenic side effects and proved useful. Low-dose estrogen-based OCs were also effective but had greater androgenic reactivity. In conclusion, low-dose OCs are suitable for treating a variety of adolescent menstrual irregularities.
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PMID:Clinical usefulness of low-dose oral contraceptives for the treatment of adolescent hyperandrogenemia. 781 Nov 85

Concerns about abnormal menstrual bleeding are a common reason for women to consult a primary care physician. The first step in the evaluation is to determine the patient's ovulatory status. Women with heavy bleeding but normal ovulatory cycles should be evaluated for coagulopathies, structural lesions, and hypothyroidism. In the absence of a systemic or structural cause, menorrhagia can be treated with OCPs or NSAIDs. Intermenstrual bleeding in OCP users may be due to noncompliance or the use of low-dose pills. Encouraging patient compliance and adjustment of the estrogen dose can often solve the problem. If the patient is not on OCPs, intermenstrual bleeding is usually due to a structural or inflammatory lesion. The differential diagnosis for anovulatory bleeding is extensive. Pregnancy, systemic illnesses, and structural lesions should be ruled out by history, physical examination, and laboratory evaluation. Endometrial biopsy is indicated in patients over age 35 and younger patients with risk factors for endometrial cancer, such as chronic anovulation and obesity. Dysfunctional uterine bleeding is a nonspecific term for abnormal uterine bleeding in the absence of systemic or structural disease. It is usually associated with anovulation. Adolescents frequently have dysfunctional uterine bleeding owing to immaturity of the hypothalamic-pituitary-ovarian axis. Perimenopausal women have an increased incidence of irregular bleeding secondary to decreased estrogen production by the ovary. Obesity, polycystic ovary syndrome, stress, crash diets, and vigorous exercise can all disrupt normal ovulatory function. Treatment options for dysfunctional uterine bleeding include oral contraceptives, cyclic progesterone, or hormone replacement with estrogen and progesterone. Patients with structural lesions or those who do not resume normal withdrawal bleeding patterns on hormone therapy should be referred to a gynecologist for further evaluation and treatment.
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PMID:Abnormal uterine bleeding. 787 94

Forty-five women with a chief complaint of abnormal vaginal bleeding from a few days' duration (spotting) to three to six months of bleeding (average, 4.5 months) were evaluated using a standard clinical approach followed by transvaginal ultrasound (US). Serum estradiol (E2), progesterone and/or endometrial biopsy was used to further clarify the etiology of the bleeding and confirm the clinical or ultrasound diagnosis. Anatomic findings were present in 31% of patients by US examination as compared to only 9% by clinical evaluation. An additional 9% of patients had polycystic ovary disease. Of the 16% of study patients on oral contraceptives with a clinical diagnosis of breakthrough bleeding, 33% had anatomic findings associated with the bleeding on US. The ultrasound image of the endometrium predicted the endometrial biopsy findings in all three patients with postmenopausal bleeding. In the remaining patients with a diagnosis of dysfunctional uterine bleeding (DUB) (a diagnosis usually made clinically by excluding other etiologies), US was helpful in excluding many patients with anatomic findings not detected by physical examination and in evaluating the endometrium, helping differentiate anovulatory from ovulatory DUB. US was helpful in predicting the hormonal and histologic endometrial status of the patients. Patients with more severe and prolonged DUB had low serum E2 with US findings of a single-line endometrium (consistent with low serum E2 and anovulation). US can be a valuable aid in evaluating women presenting with a complaint of abnormal vaginal bleeding by demonstrating anatomic findings frequently not discernible on pelvic examination, such as small cysts and leiomyomas and even endometrial carcinoma, and in evaluating the endometrium in terms of its thickness and, indirectly, the endometrial histology and the ovulatory and hormonal status of the patient. US can also be of value in confirming some diagnoses that are generally made clinically by exclusion, such as breakthrough bleeding from oral contraceptive use and DUB.
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PMID:Use of transvaginal ultrasound in diagnosing the etiology of menometrorrhagia. 806 3

A 38 year old patient with multiple known risk factors for endometrial carcinoma (monophasic cycles, obesity, familial prediabetes, nulliparity, polycystic ovaries with diffuse thecal hyperplasia) presented with metrorrhagia caused by an endometrial lesion for which the diagnosis hesitated between atypical endometrial hyperplasia and carcinoma. Hysterectomy was performed because of the presence of a bicornuate uterus, obesity of 130 kg and the patient's lack of desire to have children. Examination of the uterus did not reveal any myometrial invasion in contact with the hyperplastic endometrium. The discovery of an endometrioid carcinomatous metastasis in the lower third of the vagina one year later allowed the retrospective detection of a 3 mm endometrioid carcinoma in the isthmus. No other metastases or recurrence were observed with a follow-up of 5 years.
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PMID:[Endometrioid adenocarcinoma of the uterine isthmus associated with atypical endometrial hyperplasia and polycystic ovaries. Apropos of a case with bicornuate uterus in a 38 year old woman]. 827 61

Adenocarcinoma of the endometrium in patients 45 years old or younger accounts for 3-8% of all endometrial cancers diagnosed. Ten women of age = 45 years treated for endometrial cancer stage I in our Clinic of Obstetrics and Gynaecology from December 1979 to December 1988. Two cases were nulliparae, none of the 10 patients had Polycystic ovary syndrome and only was obese. In 80% of these cases the presenting symptom was abnormal vaginal bleeding and one patient had coexisting ovarian neoplasia (endometrioid carcinoma). Atypical endometrial hyperplasia was diagnosed in only one case. None of the patients had metastases or capillary like spaces invasion. Our policy was to treat these patients by hysterectomy (Piver 1 or 2), bilateral salpingo-oophorectomy and selective pelvic lymphadenectomy. One patient received adjuvant postoperative radiation therapy (49.5 Gy). One women was submitted two years later to radical mastectomy for ductal carcinoma of the breast. Endometrial adenocarcinoma in premenopausal women is generally of favourable histotype, at early stage and low grade, with excellent prognosis. The problem of quality of life is therefore of utmost importance. After surgical castration 4 of our patients experienced discomfort and excessive weight gain. The implications of long-term estrogen deprivation in younger patients must be seriously considered against as the change of ovarian conservation of hormonal replacement therapy.
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PMID:[Endometrial adenocarcinoma during the fertile age]. 846 59

A case of PCO syndrome associated with carcinoma of the endometrium was described at woman of 40 years old. Endometrial carcinoma was superficial and well differentiated.
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PMID:[A rare case of concurrent endometrial carcinoma and PCO syndrome]. 867 76


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