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

The surgical management of invasive and preinvasive gynecologic malignancies continues to evolve at a brisk pace. Several good techniques are available for the treatment of preinvasive cervical disease, including cryotherapy, loop electrocautery excision, laser therapy, and standard knife conization. The use of radical surgery for early invasive cervical cancer has been extended to older women, and complications have been minimized. There has been a significant trend toward more conservative surgery in the management of invasive vulvar cancer. The new surgical staging system for endometrial cancer has generated much controversy. The importance of thorough surgical staging for ovarian cancer is clear, and our understanding of the role of cytoreduction has increased. The role of new techniques, including operative laparoscopy, is being defined in the management of gynecologic cancers.
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PMID:Surgery for gynecologic malignancies. 145 8

Over the past year, a number of important papers have appeared in the medical literature dealing with the chemotherapeutic management of gynecologic cancers. Among these papers, several studies have again demonstrated the superiority of platinum-based chemotherapy regimens for ovarian cancer compared with non-platinum-containing regimens, and have confirmed the equivalence of carboplatin to cisplatin in advanced disease. A number of trials have reported activity for intraperitoneal chemotherapy regimens in patients with small-volume residual disease. In endometrial cancer, combination cisplatin-based chemotherapy programs have been reported to achieve an overall 40% to 50% objective response rate. Although induction chemotherapy has been advocated in the management of advanced localized cervical cancer, this conclusion has yet to be supported by the results of randomized trials. The etoposide, methotrexate, dactinomycin, cyclophosphamide, vincristine regimen has been demonstrated to be highly effective in patients with high-risk gestational trophoblastic tumors. Finally, a recent report has demonstrated that it is possible to perform conservative surgery in patients with germ cell tumors to preserve fertility without compromising therapeutic efficacy.
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PMID:Systemic therapy for gynecologic cancer. 145 10

Chronic GnRH analogs (GnRH-A) administration has proven to be effective for the control of some hormone-dependent tumors. GnRH-A are now in the standard treatment of prostatic cancer. In the present paper experimental and clinical data on the use of GnRH-A in gynecologic oncology are reviewed in order to identify a possible role in the therapy of breast, endometrial and ovarian cancer. Besides the indirect hormonal effect of GnRH-A, mediated by the suppression of gonadal steroidogenesis, in vitro evidence suggests a direct anti-proliferative action involving autocrine-paracrine regulation of cellular function. In advanced or recurrent breast cancer objective responses were observed in 157 out of 378 premenopausal patients (41%) and in 18 out of 166 postmenopausal women (10%). In ovarian cancer complete and partial responses were observed in 14 out of 121 (11%). At present, data on advanced endometrial carcinoma are limited: only 18 treated patients are reported, of whom 7 responded (38.8%). However, in general, most of the responses observed were transient. Thus, so far, the use of GnRH-A in gynecologic oncology has to be considered for palliation, after the failure of other better understood treatment modalities. The possible use of GnRH-A as an adjuvant is still under investigation.
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PMID:GnRH analogs in gynecological oncology: a review. 147 22

We measured the levels of thrombin-antithrombin III complex (TAT) and fibrinogen and fibrin degradation products (FDP) in 115 patients with gynecological malignancies (ovarian cancer 34, cervical cancer 34, endometrial cancer 47). These concentrations were compared to those in control groups of 15 patients with benign ovarian tumor. The levels of TAT and FDP were significantly higher in patients with ovarian cancer compared to the control group (both: p less than 0.01), and these levels were higher than in other gynecological malignancies. In stages I and II the positive rate of TAT and FDP (TAT greater than 3.0 ng/ml, FDP greater than 1.40 microgram/ml) in patients with ovarian cancer was higher than that in other gynecological malignancies. TAT and FDP were increased following cancer dissemination, and the recovery of coagulative and fibrinolytic factors (TAT, FDP) with effective treatment was correlated to the prognosis for patients with ovarian cancer. These levels had no correlation with the levels of CA125 and histological classification in patients with ovarian cancer. Accordingly, these results suggest that these changes in TAT and FDP may be useful, together with other clinical signs, in detecting early stage ovarian cancer.
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PMID:[The clinical significance of thrombin-antithrombin III complex (TAT) and fibrinogen and fibrin degradation products (FDP) levels in ovarian cancer]. 154 65

Researchers applied published data on cancer incidence and age specific mortality to standard life table techniques to estimate the lifetime probability of developing reproductive cancer for women living in countries representative of 3 patters of risk of reproductive cancer and for long term oral contraceptives (OC) users under best case, worst case, and likely case assumptions. The reproductive cancers included breast, ovarian, endometrial, and cervical cancers. The data consisted of urban women from China, Japan, United States (California), England, Wales, Costa Rica, and Colombia. Under the likely case assumption, OCs just barely reduced or increased the lifetime probability of any reproductive cancer in any setting. Further, under the worst case scenario, OCs increased the lifetime probability or reproductive cancer moderately in countries with low cancer rates (Asian countries) and in countries with high rates of breast, ovarian, and endometrial cancer (Western Europe, North America, and Australia). Yet in countries with high cervical rates (South and Central America), OC use significantly affected the lifetime probability of reproductive cancer. The best case scenario revealed that OCs decreased lifetime probability of reproductive cancer in each country, especially those countries where endometrial and ovarian cancer incidences were great. The analysis also showed that OC use has the greatest effect on lifetime probability of reproductive cancer, be it positive or negative, in countries with high underlying rates of reproductive cancer. Further it demonstrated that the effect of OC use will most likely be small in countries with low incidence of reproductive cancers. Overall the researchers felt reassured about OC use and reproductive cancer. Even though long term OC use increases the risk of breast cancer in young ages.
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PMID:Worldwide variations in the lifetime probability of reproductive cancer in women: implications of best-case, worst-case, and likely-case assumptions about the effect of oral contraceptive use. 155 40

Exogenous hormones are widely prescribed in the United States, primarily as oral contraceptives and hormone-replacement therapy. Each of these frequently used categories of drugs has important potential for altering risk of several major human cancers. The efficacy of oral contraceptives in preventing ovarian cancer and endometrial cancer is well established. There remains controversy about the relationship between oral-contraceptive use and breast cancer risk, but most studies show that use in the postmenarcheal and perimenopausal periods is associated with an increased risk of breast cancer in a duration-dependent manner. As with oral contraceptives, the relationship between estrogen-replacement therapy and breast cancer risk is controversial, but several well-designed studies showed a moderate increased risk after long-term use. Estrogen-replacement therapy is a major cause of endometrial cancer. Combination hormone-replacement therapy will probably reduce some of the excess risk of endometrial cancer, but few epidemiological data exist on this relationship. The sparse data suggest that combination therapy may enhance breast cancer risk. As with endometrial and ovarian cancers, hormonal chemoprevention of breast cancer is also feasible. We review two such strategies, ie, gonadotropin-releasing hormone agonists and the antiestrogenic drug tamoxifen.
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PMID:Relationship of hormone use to cancer risk. 161 98

This study includes 29 patients with synchronous primary malignancies of the female genital tract. These patients constituted 1.7% of all genital malignancies. The most frequently observed synchronous neoplasms were those of the ovary together with the endometrium (51.7%). Most patients had early-stage and low-grade disease. Stage I disease was observed in 68.1% of patients with ovarian cancer. Patients with synchronous ovarian and endometrial cancer had a 73.3% 5-year survival rate, suggesting a favorable prognosis.
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PMID:Synchronous primary malignancies of the female genital tract. 161 63

Epidemiologic studies of breast, ovarian, and endometrial cancer and physiologic studies of epithelial tissues from which these cancers originate indicate that medical researchers can develop interventions to reduce women's risk of these 3 cancers. They already know that use of combined oral contraceptives considerably reduced the risk of endometrial and ovarian cancer. The key etiologic factors for endometrial and breast cancer are ovarian steroid hormones. Specifically, any estrogen not checked by progestogen stimulate cell division in the epithelial tissue of the endometrium thus increasing the risk of cancer. Yet estrogen and progestogen induces significantly more cell division in the epithelial tissue of the terminal duct lobular unit (from which many breast cancers originate) than does just estrogen. Ovulation damages the ovarian surface making it the leading etiologic factor for ovarian cancer. Medical researchers at the University of Southern California (USC) have designed a prototype contraceptive regimen which should prevent all 3 cancers. They re presently testing it in a clinical trial at USC. The prototype regimen consists of administration of the gonadotropin releasing hormone agonist (GnRHA) leuprolide acetate depot on day 1 of each 28-day cycle, 0.625 mg of oral conjugated equine estrogens (CEE) on Monday-Saturday (24 days) per each 28-day cycle, and 10 mg of oral medroxyprogesterone acetate (MCA) for 13 days every 4th cycle. The GnRHA reduces the risk of all 3 cancers. CEE prevents bone mineral loss, possible increase in cardiovascular disease risk, menopausal symptoms, and urogenital atrophy. MCA reverses endometrial hyperplasia and prevents increased risk of endometrial cancer. The predicted relative reduction in lifetime breast cancer risks over 5,10, and 15 years for the prototype regimen are 31%, 53%, and 70%, respectively. For endometrial cancer, they are 18%, 33%, and 45%, respectively. For ovarian cancer, they are 41%, 67%, and 84%. This regimen should also reduce the incidence or severity of hormonally mediated benign gynecologic disorders. Further research on such a regimen is needed.
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PMID:The prevention of breast cancer through reduced ovarian steroid exposure. 162 31

We have constructed deletion maps of chromosome 3p for cancers of the female genital tract (uterine endometrium, uterine cervix and ovary). The tumours were tested for loss of heterozygosity using CA-repeat polymorphisms. The high degree of informativeness of these markers allowed the construction of detailed deletion maps from a relatively small number of samples. A common region of deletion was identified at chromosome 3p13-21.1 in endometrial cancer and at 3p13-14.3 in cervical cancer; 5 out of 13 (38%) endometrial cancers and six out of eight (75%) cervical cancers showed loss of heterozygosity at these regions. In ovarian cancer a separate common region of deletion was identified at 3p21.1-22; two out of four (50%) ovarian cancers had alleles deleted at this region. These data suggest the presence of a tumour-suppressor gene(s) for endometrial and cervical cancer at 3p13-21.3 and a separate gene at 3p21.1-22 that is involved in the carcinogenesis of ovarian cancer.
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PMID:Deletion mapping of chromosome 3p in female genital tract malignancies using microsatellite polymorphisms. 163 Aug 22

Since hormones relate to the etiology of breast cancer, 40 studies have looked at the possible association of oral contraceptives (OCs) with breast cancer. Most research conducted through 1986 and including the largest related case control study and several after 1986 found no association between ever use of OCs and breast cancer. On the other hand, some studies conducted after 1986 with women 45 years old who had breast cancer and had taken OCs have suggested a dose response relationship, 2 fold increased risk of breast cancer, or increased risk with duration of OC use. These results motivated several organizations to review the literature and to issue guidelines. The US Food and Drug Administration, the UK Committee on the Safety of Medicines, and IPPF did not find a reason to change practices. The Committee on the Safety of Medicines did suggest, however, that health providers mention the possible increase in risk. At least 8 studies have revealed an increased risk of cervical cancer with duration of OC use, especially after 5 years of use. Yet experience has disclosed an obstacle to understanding the relationship between cervical cancer and OC use--cervical cancer may be caused by the human papilloma virus transmitted by sexual intercourse. Unlike results of breast and cervical cancer research, research results have clearly established that OC use lowers the risk of endometrial cancer by about 50% and the risk of ovarian cancer by about 40%. In fact, the US Cancer and Steroid Hormone [CASH] study showed a protective effect of OCs for endometrial and ovarian cancers at least 15 years after discontinuation. Even though some studies found a dose response effect with duration of use, a large international study did not find any relationship between OC us and liver cancer. Moreover studies did not reveal an association between OC use and malignant melanoma or pituitary adenoma.
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PMID:Neoplastic effects of oral contraceptives. 167 77


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