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

Transrectal ultrasonographic examinations before surgery were performed on 27 patients with stage I endometrial cancer to assess myometrial invasion. The findings were compared with the histopathologic data obtained by surgery. Sensitivity and specificity of transrectal ultrasonography in myometrial invasion of endometrium cancer were 82.6 and 100%, respectively. Therefore, transrectal ultrasonography may be a useful diagnostic tool to determine the myometrial invasion, which is the most important prognostic factor in endometrial cancer.
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PMID:Myometrial invasion of endometrium cancer assessed by transrectal ultrasonography. 174 19

Today the endometrial carcinoma is the most frequent malignant tumor found in female genital tract. Endometrial carcinoma ought to be operated in all cases, if possible. Traditionally some form of adjuvant radiotherapy has been given. Despite the large number of patients treated by combined therapy over the last 30 years, surprisingly there is a lack of hard data on which to establish a theory for an improved outcome. It is generally accepted that the risk of local relapses in the vagina is lowered when postoperative vaginal irradiation is applied. The question of the value of additional external irradiation in stage I endometrial cancer still is unsettled. Only two prospective studies led to the conclusion that only patients with poorly differentiated tumors and with deep infiltration of the myometrium might benefit from additional external radiotherapy. Therefore a simple score for these risk factors is proposed enabling assignment into patient groups of similar risk on the base of a point system due to individual prognostic factors. With a score of one to two points prognosis is very good and adjuvant irradiation seems not to be necessary. With three to four points local vaginal irradiation is recommended, with five and more points additionally external beam irradiation to the pelvis should be given. This is necessary in more than the half of the operated cases of endometrial carcinoma. The indication for such a treatment has become more individual and "high risk" cases are treated more intensively, but "low risk" cases have to be excepted from unnecessary adjuvant therapy. In order to judge an individual case of endometrial cancer histopathologic prognosticators have to be considered. Typical adenocarcinomas have a five-year survival of more than 80%, but unfavourable subtypes (adenosquamous, clear-cell, serous-papillary carcinomas) of only 40%, respectively. Tumor grading and depth of myometrial invasion are of high importance for individual prognosis. The new histopathologic staging system of FIGO (1988) takes these items into account. Only patients with severe internal diseases should be treated with radiation therapy alone. Although radiation therapy alone can cure endometrial cancer (five-year-survival approximately 60%), the survival figures are poorer than for the operation (five-year survival 80%, respectively). It should be outlined that in inoperable cases radiotherapy is the best form of treatment.
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PMID:[The value of and indications for radiotherapy in endometrial carcinoma]. 185 12

Vaginal hysterectomy was performed on 31 patients with stage I endometrial cancer because of medical problems which placed them at high risk for morbidity and mortality from abdominal surgery. These risk factors included morbid obesity (87%), hypertension (58%), diabetes mellitus (35%), and cardiovascular diseases (26%). The perioperative morbidity was minimal, with only four patients (13%) experiencing complications requiring extended hospital stays and no deaths. Adjuvant radiotherapy was administered in 35% of patients with either deep myometrial invasion or unfavorable histology. The 3- and 5-year disease-free survival rates were 100 and 93%, respectively. The only cancer-related death occurred 4.5 years following surgery. Although the authors are not advocating vaginal hysterectomy as standard treatment of endometrial cancer, this approach provides an acceptable alternative to abdominal surgery in the medically compromised patient.
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PMID:Use of vaginal hysterectomy for the management of stage I endometrial cancer in the medically compromised patient. 198 19

A prospective study was conducted on 50 consecutive patients with stage I endometrial cancer who had primary surgical treatment. The purpose of the study was to assess the value of magnetic resonance imaging (MRI) for accurate staging of early disease and determination of myometrial invasion. Features identified by MRI were correlated with surgical pathology. Preliminary MRI results provided additional valuable information. All but one of 18 patients with histologically proven deep myometrial invasion were predicted preoperatively by MRI. Of 17 patients with detached fragments of malignant tissue in the endocervical curettage (ECC) but with results inconclusive for actual cervical invasion, MRI revealed all three patients with true cervical tissue involvement. Magnetic resonance imaging detected all six patients with gross extrauterine spread and also precisely measured uterine enlargement by myomata. The extent and location of tumor growth in the uterus could be mapped out in the majority of cases. Based on these findings, a pretreatment MRI scan of the pelvis in presumably stage I endometrial carcinoma resulted in an advance in staging in 18% of the patients, and accurately predicted deep myometrial invasion in 94% of the cases. Inclusion of MRI in the routine work-up in stage I endometrial carcinoma should be considered for proper clinical staging, particularly in patients with a positive but nondiagnostic ECC, uterine papillary serous carcinoma, or grade 3 tumor.
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PMID:Magnetic resonance imaging in stage I endometrial carcinoma. 230 Mar 56

Extended surgical staging (ESS) has been added to total hysterectomy and bilateral salpingo-oophorectomy (TAHBSO) in patients with clinical Stage I endometrial cancer in order to better define patterns of metastatic spread and the response to treatment. Adjuvant radiotherapy has a demonstrated efficacy in decreasing central recurrence in Stage I disease. The combined use of radical surgery and pelvic radiotherapy for cervical cancer patients results in an increased incidence of complications. This study compares major complication rates in Stage I endometrial cancer patients who underwent either TAHBSO with ESS or TAHBSO alone followed by adjuvant external beam radiotherapy (RT). Records of 52 patients with clinical stage I endometrial cancer were reviewed. Thirty-two patients underwent TAHBSO plus ESS and 20 patients had TAHBSO alone. All patients received postoperative, whole pelvis external radiotherapy. Four patients suffered complications potentially related to treatment which required rehospitalization, and all 4 were in the group which had undergone ESS. A comparison of complication rates between the ESS + RT group (4/37 or 10.8%) and TAHBSO + RT group (0/20) suggested a trend toward significance (P less than 0.10). Treatment protocols using extended surgical staging prior to adjuvant radiotherapy in Stage I endometrial cancer should examine complications potentially related to this combination, to further define treatment risks and benefits.
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PMID:Hysterectomy with extended surgical staging and radiotherapy versus hysterectomy alone and radiotherapy in stage I endometrial cancer: a comparison of complication rates. 231 52

Magnetic resonance (MR) imaging may aid in preoperative treatment planning of endometrial carcinoma by accurately estimating tumor volume, depth of myometrial invasion, and extrauterine extension. Preoperative MR scans were obtained on 24 women with clinical stage I endometrial cancer. MR scans were evaluated for uterine size, as an indirect measure of tumor volume, and depth of myometrial invasion. MR detected deep invasion (greater than or equal to 50% of myometrial thickness) with a sensitivity of 71% and specificity of 83% (accuracy 79%) when compared with the pathologic findings. MR staging may assist in deciding which patients should have lymph node dissection at surgery and may aid in decisions regarding adjunctive radiation therapy.
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PMID:Magnetic resonance imaging in the preoperative assessment of clinical stage I endometrial carcinoma. 234 26

Management of early endometrial carcinoma is controversial in regard to timing and indication of adjunctive radiation therapy. Two hundred eighty patients with stage I carcinoma of the endometrium are analyzed: 135 patients were treated with surgery only and 61 patients underwent preoperative and 83 patients postoperative radiation therapy. The overall survival was 94%. Recurrence rates in all three treatment arms were equal. Tumor grade was found to change from the diagnostic D&C specimen to the definite surgical specimen in 31% of all cases and in 50% of all grade 3 lesions. As only 39% of all patients required postoperative radiation therapy with equal survival, a primary surgical approach spares the majority of patient unnecessary treatment and preserves prognostically important histology.
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PMID:Management of early endometrial carcinoma. 259 73

The influence of radiation therapy on cell-mediated immune reactions in cancer patients seems to depend on source, dose, and area of irradiation, as well as on the variables reflected by the patient population investigated. In the present study we demonstrated that brachytherapy (192Ir afterloading), applied to patients with inoperable stage I endometrial cancer, has no immediate or sustained effect on lymphocyte function. Both lymphocyte mitogen response and natural killer cell (NK) activity are not significantly changed in terms of baseline values compared with test results during and after therapy. Brachytherapy, as used in this study, has no influence on cell-mediated immunity in patients with endometrial cancer stage I.
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PMID:Influence of brachytherapy (192Ir afterloading) on cell-mediated immune reactions in patients with stage I endometrial cancer. 280 7

Adenocarcinoma of the endometrium is considered to be an estrogen-dependent neoplasia and as such, hormone replacement therapy is said to be contraindicated. The authors are unaware of any data to substantiate that statement. Patients, who had completed their therapy for stage I carcinoma of the endometrium, were placed on estrogen hormone replacement therapy in a nonrandomized fashion. Between 1975 and 1980, 221 patients with stage I adenocarcinoma of the endometrium were managed at the Duke University Medical Center. Forty-seven patients received estrogen after their cancer therapy, whereas 174 patients did not. Risk factors for recurrence were similar between the two groups. After controlling for these known risk factors, the estimated distributions of time to recurrence for the two groups were significantly different (P less than .05), with the estrogen group experiencing longer disease-free survival. The history of endometrial cancer does not appear to be a contraindication to hormone replacement therapy in patients with stage I disease.
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PMID:Estrogen replacement therapy in the patient treated for endometrial cancer. 300 36

The data on 19 cases of primary endometrial carcinoma, stage I (mean age 28.0 years), cured by the administration of hydroxyprogesterone caproate without surgery and radiation therapy are presented. Clinical recovery in 15 cases was confirmed by repeated cytological and histological examinations of the endometrium. Hydroxyprogesterone caproate dose per course ranged within 25.0-83.0 g. In 4 patients with moderately differentiated cancer (G2), hormonal treatment was carried out in combination with chemotherapy. When tumor regression was confirmed histologically, steroid contraceptives were administered to induce an artificial menstrual cycle. At the closing stage of therapy clomiphene citrates were given in succession to restore the ovulatory cycle. Perspectives of administration of progestogens in young women with stage I endometrial carcinoma as a separate method of therapy are discussed.
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PMID:Can primary endometrial carcinoma stage I be cured without surgery and radiation therapy? 397 84


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