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

An understanding of the basic mechanisms of hormone action is becoming an important part of a clinician's training. With the advent of radioreceptor assays and their comparison with radioimmunoassays, we are becoming increasingly aware that the normal physiological function of a hormone is not necessarily dependent on "normal" levels of hormone being present in the plasma. Even if plasma levels are normal, if a particular target cell lacks the receptor for the particular hormone the target tissue will not respond to the hormone. It has been shown, for example, by many workers that steroid hormones act on their cells via a receptor located in the cytoplasm of the target cells (1-4). Since the presence or absence of such receptors are becoming increasingly important in terms of unexplained infertility, endometrial carcinoma and breast cancer, it is necessary that the practicing clinician be familiar with the concept of receptors and have some understanding of their mode of action. In this brief presentation, I will explain certain terminology and summarize the state of the art so that you can critically read the literature concerning new developments in the area of hormone action which is to become increasingly important in the next few years. I will discuss some of the aspects of the mechanism of peptide hormones such as LH and FSH but will devote most of my attention discussing the details of steroid hormone action since our knowledge in this area is much more complete. I will also explain the terms frequently discussed in the literature concerned with hormone-receptor interactions.
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PMID:Hormone-receptor interactions--basic mechanisms. 1 18

A long experience in the treatment of endometrial cancer shows that the therapeutic measures vary considerably with regard to the extention of the tumor, the age of the patient and her general condition. This circumstances and particularly the critical study of the therapeutical results give the limits, within a certain kind of operation can reasonably be recommended. The intercurrent deaths are an important factor in the statistical evaluation of therapeutical success. As long as the tumor is limited to the body of the uterus, the corrected 5-year recoveries are about 90%. Considering all the circumstances, it becomes obvious, that in this stage, the simple abdominal hysterectomy with removal of the adnexa is still the operation of choice. Beside the histological degree of differentiation, the depth of the muscular invasion is the most important prognostic factor which might lead to additional measures. Postoperative radiation therapy of the vagina reduces considerably the incidence possibility of vaginal apex recurrence. In stage II radical hysterectomy must be considered, although we are aware of the fact, that a simple hysterectomy and bilateral salpingo-oophorectomy combined with radiation treatment may yield just as good results. In the clinical stage III laparotomy ought to be used more frequently. Also in case of operative intervention additional radiotherapy is mostly useful.
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PMID:[Aminoacid-p-nitroanilides splitting activities in the mature human placenta (author's transl)]. 1 5

The relationship between monopausal estrogen treatment and endometrial cancer is discussed. One must consider the facultative co-carinogeninity of certain hormones. In lower dosages they may have a terrain effect or unspecific permissive effect on the development of cancer, yet when used in high dosages, e.g. estriol, they can inhibit cancer growth. There are also many predisposing factors to developing cancer which should be taken into consideration when interpreting research results. Although American studies have shown a relationship between therapeutic menopausal estrogen treatment and endometrial cancer, European studies indicate that there is no increased risk if certain guidelines are followed. These include: cyclical treatment, lowest possible hormone dosages, use of gestagen, use of estriol where possible, and consideration of predisposing factors. These guidelines were not followed in the U.S. studies.
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PMID:[Estrogens and endometrial carcinoma. Position paper on the publication of the drug commission]. 3 20

The concensus conclusions reached at a concensus development conference on Estrogen Use and Postmenopausal Women in September 1979 are based on 3 position papers prepared for the conference, the response of the panel, and the general discussion by the audience, followed by the panel and other conference participants. The evidence for the efficacy of estrogens in treating specific conditions associated with menopause was reviewed 1st. It was accepted that estrogens are more effective than placebo in decreasing the frequency and severity of vasomotor symptoms. Estrogens are effective in overcoming the atrophy of the vaginal epithelium and the associated symptoms. Present evidence does not justify the use of estrogens to treat primary psychological problems. The validity of 3 randomized trials indicating that exogenous estrogens can retard bone loss if given around the time of menopause was acknowledged. There is no convincing evidence that estrogens in customary doses increase the risk of thromboembolic phenomena, stroke, or heart disease in women who have undergone natural menopause. Evidence was also reviewed concerning adverse effects associated with post-menopausal estrogen use. In the absence of exogenous estrogens, the incidence of endometrial cancer is about 1/1000 postmenopausal women per year. This rate increases severalfold beginning after about 2-4 years of use of 0.625 or 1.25 mg of conjugated estrogens daily. Cystic hyperplasia of the endometrium, regarded as a premalignant condition, has been associated with unopposed estrogen, whether endogenous or exogenous.
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PMID:Estrogen use and postmenopausal women: a National Institutes of Health Consensus Development Conference. 4 37

In response to a recent report (Fam Plann Perspect 11: 47, 1979) that two of 12 rhesus monkeys given 50 times the human dose of depot medroxyprogesterone acetate (DMPA), by body weight, for ten years had developed endometrial carcinoma (CA), a retrospective survey of all hospital admissions for proven endometrial CA in two Thai provinces where DMPA contraceptive injections have been widely used since 1965 was made. From 1974 through 1978, 16 women were hospitalized with confirmed diagnoses of endometrial CA. None of the nine women successfully followed up had previously used oral or injectable contraceptives, nor has the recorded incidence of endometrial CA increased in these provinces. Base on the available evidence, the authors conclude that (a) the data on monkeys given very large doses of DMPA for ten years do not apply to women given normal doses of DMPA for prolonged periods and (b) widespread and long-term use of DMPA can and should be continued.
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PMID:International forum update: depot medroxyprogesterone acetate and endometrial carcinoma. 4 91

Circulating carcinoembryonic antigen (CEA) and alpha fetoprotein (AFP) levels were measured by radioimmunoassay in 53 patients with carcinoma of the ovary, 16 patients with other malignant genital tumors, and 31 women with nonmalignant diseases of the genital tract. The serum CEA concentration was elevated (greater than 5 ng/ml) in 11 patients with ovarian cancer, 2 patients with endometrial cancer, 1 patient with carcinoma of the cervix, and 1 patient with a benign embryonal cystic teratoma. Elevated CEA levels were found only in patients with advanced malignant disease, while early stages were associated with normal CEA concentrations. AFP levels were normal in all but 1 patient. Both CEA and AFP levels were markedly raised in a case of advanced genital carcinoma arising probably from the ovary. Ascitic fluid of another patient with ovarian cancer contained a high concentration of CEA, giving an identical reaction in immunodiffusion with CEA from colon cancer. The present results indicate that while the increased expression of carcinofetal components takes place in some malignant tumors of the female genital tract, it is usually a late phenomenon.
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PMID:Carcinoembryonic antigen and alpha fetoprotein in malignant tumors of the female genital tract. 4 62

Many scientists have criticized the mandatory use of dogs for studies of the chronic toxicity of synthetic steroidal contraceptive hormones. The estimated annual incidence rates for cancer of all sites in dogs is 381.2/100,000 dogs. The estimated relative risk (R) value for the occurrence of tumors in the Beagle breed is 0.9; for malignant tumors, the R value in the Beagle is 0.8. A review of the hormonal potency of various contraceptive steroids in the Beagles indicates that progestogenic compounds generally produce a much lower progestational activity in dogs than in women, and the the predominant hormonal action of norethisterone in dogs is estrogenicity rather than progestogenicity. This weak activity for the canine species may account for some of the toxicological findings for norethisterone and related compounds in the Beagle. It is also possible that there are species differences in the relative affinities of estrogen and progesterone receptors for contraceptive steroids. Studies on long-term administration to female Beagle dogs suggest that the nodules found in the mammary gland are not histologically comparable to mammary tumors found in the human female although there is a superficial morphological resemblance to some forms of human mammary dysplasia. Several authors suggest that the results of testing progestational compounds in Beagles are unlikely to be indicative of a potential hazard to the human female. In testing megestrol acetate, it is suggested that the unique sensitivity of the canine females to megestrol acetate is exemplified by intense mammary development at dose levels 10 times the human oral contraceptive level. In contrast, daily dose levels of 500 mg/day in women as a palliative for endometrial cancer have been used with no serious side effects or mammary enlargement. Also the canine mammary gland produces certain pathological changes following administration of natural or synthetic progesterones in a way not readily seen in other species. Possible alternative models (cat, pig) for contraceptive steroid toxicological studies and recommendations for future research are discussed.
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PMID:Contraceptive steroid toxicology in the Beagle dog and its relevance to human carcinogenicity. 6 32

Two hundred patients at high risk for endometrial adenocarcinoma were screened using the Gravlee Jet Washer. Tissue obtained from the first 100 patients was processed by cell block technic alone; tissue from the second 100 patients was processed by cell block plus direct smear and Nucleopore filtration stained by the Papanicolaou method. All patients had histologic diagnosis by fractional curettage. Six of 12 patients with a tissue diagnosis of carcinoma were missed by the jet washer using the cell block technic alone. In the second 100 patients, no cases of cancer were missed using both cell block and cytologic technics. Technic and application of the jet washer in screening for endometrial carcinoma are discussed. We conclude that the Gravlee Jet Washer is a safe, effective screening tool which frequently may replace diagnostic curettage; however, if abnormal bleeding persists, curettage must be done.
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PMID:Evaluation of the Gravlee Jet Washer using combined cell block/cytologic interpretations. 6 43

Of 1029 dilatation-and-curettage operations carried out in a 12-month period, more than half were in women aged under 40, and 38% were for menstrual disturbances. The yield of intrauterine disease in these groups was low--curettage for post-menopausal bleeding or discharge in 150 women detected 15 endomettrial carcinomas and a similar number of other endometrial lesions. The complication-rate resulting from curettage was 1.7%--i.e., equivalent to the overall rate of detection of endometrial carcinoma. Selection of patients submitted to uterine curettage could be better, but postmenopausal bleeding remains an indication for mandatory uterine curettage.
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PMID:Critical assessment of dilatation and curettage in 1029 women. 7 28

A proportion of cancers in endocrine target tissues can show the presence of specific receptors for either steroid or polypetide hormones. Manipulation of the controlling hormones does not guarantee regression. A third of cancers in endocrine target organs (breast, uterine endometrium, and prostate) show a 50% reduction in size of lesions after hormonal therapy. If regression resulting from an aggressive form of therapy lasts a short while and the tumor reactivates by the time the unpleasant effects of the therapy wear off, the treatment is not palliative. Endocrine therapy in prostatic cancer is palliative but there is no evidence that is increases survival. 11 different progestational agents in endometrial cancer therapy in the past 25 years resulted in a 30-35% response. Response must be maintained by continual treatment and may last from 12 months to 7-8 years. In breast cancer, tumors with a significant level of estrogen receptor (ER+) have about a 60% chance of regression vs. tumors without estrogen receptors (ER-), 10%. Advanced cancers of the thyroid of the papillary or follicular type regress when the patient is treated by thyroxine, .3 mg daily. Leukemia and lymphoma are frequently treated, with varying degrees of success with corticosteroid therapy, which may also predispose the patient to intercurrent infection. Renal cancer has been often treated by medroxyprogesterone acetate or testosterone propionate, with little success.
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PMID:Endocrine therapy in cancer. 8 86


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