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

The effectiveness of monophasic and multiphasic oral contraceptives (OCs) depends on their ability to suppress ovulation, change endometrial growth and ovum receptivity, and reduce cervical mucus receptivity to sperm. They are all more than 99% effective, but, depending on the type and dose of hormone components, they have different side effects. The estrogen component (ethinyl estradiol) of most new OCs is between 30 and 35 mcg, which reduces the risk of estrogen side effects, especially thromboembolism and hypertension. The Food and Drug Administration does not recommend use of an OC with an estrogen component for lactating mothers, while the American College of Obstetrics and Gynecology and the American Academy of Pediatrics believe it is fine. Estrogen may protect against coronary artery disease, yet the estrogen component of today's OCs is so low that the progestin component may cancels this beneficial effect. It also prevents breakthrough bleeding. The most frequently used progestins in OCs are norethindrone and norgestrel. They prevent ovum implantation, sperm penetration through the cervical mucus, and ovulation. Progestins, especially norgestrel, increase the risk of coronary artery disease. Other side effects include acne and weight gain. Progestin benefits are reduced menstrual blood loss, pain during menstruation, premenstrual tension, and endometrial cancer risk. The ideal estrogen-progestin balance depends on the individual, but the estrogen component should be between 30 and 35 mcg, and the progestin component should be the lowest possible dose to reduce metabolic side effects. If an OC user with a well stabilized cycle who takes another recently prescribed drug experiences unexpected breakthrough bleeding or spotting, this change may indicate a drug interaction. Absolute and/or possible contraindications of OC use are smoking after age 35, history of breast or endometrial cancer, liver disease or impaired liver function, cardiovascular risk factors, and diabetes mellitus.
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PMID:Benefits and risks of oral contraceptive use. 143 13

Among 50-year-old women, about 30%, will suffer from osteoporosis resulting in vertebral compression, pain, and possible disablement; this represents a cost of over 4 billion French franco, and therefore necessitates a prevention policy. It has been established that estrogens applied in a dose-dependent manner have a preventive action against bone loss during the treatment period. The action of nor-steroid progestatives and anti-estrogens is likely, although this has not been fully demonstrated. Estrogens, when administered alone, increase the risk of endometrial cancer; however, this risk seems to be reduced by the addition of progestatives over a minimal period of time. Regarding breast cancer, it seems that substitutional hormone treatments for menopause only increase the risk of the above cancer after a prolonged period of over 10 years. The role of progestatives in breast-cancer risk remains uncertain, and is a subject of controversy. It therefore seems justified to prescribe substitutional hormone treatments combining estrogens and progestatives for young women in whom treatment for non hormone-dependent cancers of the cervix, ovary, etc has resulted in castration. For women who have been treated for breast or endometrial cancer, we are of the opinion that the treatment of choice should consist of non-hormonal treatments for prevention of osteoporosis.
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PMID:[Prevention and treatment of postmenopausal osteoporosis in women treated for cancer]. 146 91

Endometrial sampling with Gynoscann was performed in the outpatient department in 70 women with abnormal vaginal bleeding prior to dilatation and curettage (D&C). Successful endometrial sampling was achieved in 62 (89%) patients; Of the samples obtained 44 (71.0%) were adequate for cytological assessment and 46 (74.2%) for histological assessment, compared to 80% of D&C samples being adequate for histological examination. In those patients in whom outpatient endometrial sampling was adequate, both the cytological and histological diagnosis agreed with the D&C. The outpatient endometrial sampling was well tolerated by the patients since the majority (89%) experienced either no or little pain. Vaginal bleeding following the procedure was minimal in all except 1 patient. Endometrial sampling with Gynoscann may be useful for endometrial assessment prior to commencement of hormonal therapy and hysterectomy. It is a potentially useful screening test for early detection of endometrial cancer in patients at risk.
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PMID:The diagnostic value and patient acceptability of outpatient endometrial sampling with Gynoscann. 158 42

The purpose of this prospective clinical trial was to determine the reliability of the Pipelle endometrial biopsy instrument in recovering adequate tissue for confirmation of the diagnosis of endometrial cancer in patients with known endometrial carcinoma, and to compare endometrial histology of the sampling specimen with that of the subsequent hysterectomy specimen. Forty patients were enrolled in this study. All biopsies were performed in the office without anesthesia. The patients had a median age of 62 years (range 40-83). Discomfort was reported by the patient as mild, moderate, or severe; only two patients (5.0%) reported severe pain. There were no complications experienced with endometrial sampling. Thirty-nine of 40 specimens (97.5%) confirmed endometrial carcinoma; therefore, this study yielded a 97.5% sensitivity for the Pipelle endometrial sampling device. Comparing Pipelle and hysterectomy histology for individual patients, the histologic grade was the same in 29 (74.4%), while the Pipelle demonstrated a more advanced degree of differentiation in five (12.8%) and a lesser degree in five (12.8%). There was no residual tumor identified in one hysterectomy specimen (2.5%). Among the 12 patients who had a D&C for diagnostic purposes before referral, the Pipelle biopsy correlated with the D&C histology in ten of 12 (83.3%) and revealed a more advanced grade of tumor in one (8.3%) and a more differentiated grade in one (8.3%). In one patient, the D&C histology was adenocarcinoma grade 1, with the Pipelle demonstrating atypical hyperplasia and the hysterectomy specimen interpreted as endometrial adenocarcinoma in situ. This study demonstrates the Pipelle to be an accurate device for endometrial sampling in patients with endometrial carcinoma.
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PMID:Pipelle endometrial sampling in patients with known endometrial carcinoma. 203 Aug 77

Endometrial biopsy can be used to evaluate women at high risk for endometrial cancer and to follow women on hormone replacement therapy. Biopsy methods may produce enough pain, however, to lower patient acceptance. The Endometrial Pipelle is a new plastic endometrial suction curette that provides a histologic biopsy. This study compared the performance of the Pipelle to that of the Vabra aspirator, a widely accepted biopsy device. Endometrial sampling using both techniques was performed on 56 patients. Both instruments provided the correct diagnosis in 50 patients (89%). The Pipelle obtained more tissue than the Vabra in 28 patients (50%) and was noted by the clinician to cause less pain in 50 patients (89%). Forty-seven patients (84%) stated that biopsy with the Pipelle was less painful than with the Vabra. These results suggest that the Pipelle is as efficacious as the Vabra aspirator and has greater patient acceptability.
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PMID:Comparison of endometrial biopsy with the endometrial Pipelle and Vabra aspirator. 338 97

Screening methods for detecting more accurately carcinoma of the endometrium is becoming increasingly important because of the rising incidence of the condition. Inocurette has recently been invented to combine a scraping action with suction. This study investigates 385 patients who were admitted for diagnostic curettage or hysterectomy to which were added a series of 120 patients who were examined as out patients. Inocurette has a sensitivity of 86% and a specificity of 99%. It therefore can be considered as a reliable method of screening for the limits within which fractional diagnostic curettage should be used. Marked pain and great difficulty in introducing the apparatus made its use limited in respectively 15% and 14.5% of cases. So, the method is acceptable and useful within these limits. The results could be improved if on the one hand a thinner apparatus could be designed and on the other hand a substance could be found to soften the cervix so that it became easier to introduce the apparatus.
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PMID:[Early diagnosis of premalignant and malignant lesions of the endometrium. Evaluation of a device for collecting intrauterine samples (the Inocurette) compared with exploratory curettage]. 381 52

Endometrial carcinoma is a disease of menopausal and postmenopausal women with 74% of cases occurring between the ages of 50-69 years and 16% at age 70 or older. Recent reports suggest an increase in the frequency of the lesion and occurrence at an earlier age. Any single test by most of the conventional methods will miss about 50% of the carcinomas of the endometrium. To obtain greater accuracy in diagnosis, it is necessary to obtain large numbers of well-preserved cells directly from the endometrial cavity. Cervical patency should be proved in the examination of all postmenopausal women. The device described uses a silicone rubber tube 33.5 cm in length and 2 mm in diameter. A wire stylet for stiffness and a rounded plastic tip facilitate passage through the sometimes stenotic cervical canal. Near the tip many small holes permit aspiration of endocervical secretions. A plastic collar around the tubing facilitates the aspiration. An aspirating syringe adapter is needed. After conventional Pap smears are obtained the aspirating tube is passed into the uterus. Little or no pain is produced. Negative pressure for aspiration is obtained with a syringe. The contents of the aspirating tube are expelled onto a slide. The slide preparations are immediately fixed in a bottle of absolute alcohol containing 3% glacial acetic acid. The acid lyses most red blood cells. This method was used in 983 outpatients and 500 hospitalized patients. There were only 5 patients in whom the endometrial aspirator could not be passed, due to previous cervical trauma in 3 and vaginal atrophy and distortion in 2. No uterine perforations or infections occurred. There were no positive tests for carcinoma in the 983 outpatients. Endometrial carcinoma was diagnosed histologically in 32 of the 500 hospitalized patients. IN 27 of these 32 cases the endometrial carcinoma had been detected by cytological examination of the aspirate. There were 5 carcinoma cases in which the aspirate did not show malignant cells. In 3 of them external radiation had been given prior to surgery and some residual cancer was found in the hysterectomy specimen. Excessive blood on the slide had prevented adequate cytologic evaluation in the other 2. In 6 cases adenocarcinoma was suspected from the examination of the aspirate but not found histologically. 4 of them showed abnormal endometrial curettings. Polyps were found in 3 and hyperplasia in 1. 8 cases of in situ or early invasive carcinoma of the cervix were discovered. Results show that the method is safe and accurate to an 84.4% degree for detecting endometrial adenocarcinoma. In an accompanying discussion, better fixation of material on slides was suggested. Annual mass population screening by this method was not considered practical. Others have depended on a jet wash of the endometrium and on endometrial biopsies to obtain material for histologic study, but many patients do not like having the needed dilatation and fail to return for reexaminations.
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PMID:An acceptable yearly screening device for endometrial carcinoma. 459 64

Of 393 patients treated at Tufts-New England Medical Center for endometrial carcinoma from 1968-1977, 66 patients underwent radiation therapy alone because of medical contraindications to surgery. The median age for this group was 70 years. The patient distribution was Stage I (39), Stage II (11), and Stage III and IV (16). Therapy consisted of pelvic irradiation to a dose of 4000-5000 rads followed by an intrauterine radium application (3000-5000 mg hr.) and a vaginal radium application (2000-4000 rads to the surface). Local control was achieved in 37 of 50 patients with Stages I and II disease with a three-year actuarial survival of 78%. Patients with Stages III and IV disease had a median survival of 15 months; 4 of 16 patients survived for 36 months. In this group of patients, bleeding pain, and vaginal discharge was palliated. Four patients in the series had treatment-related bowel complications requiring colostomy. This is an effective method of treatment for endometrial carcinoma patients who are not surgical candidates.
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PMID:Treatment of endometrial carcinoma with radiation therapy alone. 707 62

Of 332 patients for whom endometrial biopsy was indicated, vacuum curettage by the Vabra method was performed on 296 (89%) women as an outpatient procedure without anesthesia. The age range was 23-71 years, with a mean of 45.7. Material sufficient for histological diagnosis was obtained in 276 (93.3%), 7 (2.4%) of whom had endometrial cancer, 14 (4.7%) who had adenomatous hyperplasia, and 29 (9.8%) who had cystic hyperplasia. Of the 20 patients in whom the curettings could not be assessed, subsequent conventional curettage showed postmenopausal mucosa in 12 cases, endometrial polyps in 4, and atrophic mucosa due to the oral contraceptive pill in 4. 47 (15.8%) and 7 (2.3%) patients experienced moderate and severe pain respectively, and 2 (0.6%) had a vasovagal reaction. There was 1 case (0.3%) of endometritis and 6 (2%) of postoperative bleeding. During a follow-up period of 1-5.5 (mean 2.4) years, 16 patients have developed bleeding again, but repeated vacuum curettage disclosed benign conditions in all, with no endometrial cancer apart from the cases diagnosed primarily. Vacuum curettage is a quick, simple, and cheap method for histological diagnosis of endometrial tissue. It does not require anesthesia, patient acceptability is high, and reliability is satisfactory.
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PMID:Vacuum curettage by the Vabrar method. A simple procedure for endometrial diagnosis. 714 13

Lately there is a tendency for an increase in the incidence of endometrial cancer both in this country and other industrialized countries such as the United States. The routine cervicovaginal smear method is generally poor for the detection of endometrial carcinoma as compared to that used for the diagnosis of early cervical neoplasms. The principal reason for the poor detection rate is that the cells are not obtained directly from the lesion as is the case with disease of the cervix. Various techniques for obtaining endometrial cells directly from the lesions have been described, but none has enjoyed wide acceptance by the clinicians. The patients for this study consisted of 138 women who were referred to us for diagnostic curettage. We employed the new disposable device, the Endocyte, and Masubuchi's endometrial aspiration and compared the results. After obtaining specimens with both methods curettage was performed on all patients. In addition, the Endocyte was employed on 8 patients with endometrial carcinoma in another hospital, and the following results were obtained. 1. With the Endocyte it is possible to obtain a larger volume of cells than by aspiration. 2. Although a certain amount of difficulty is encountered in the insertion of the Endocyte in some cases, it is much easier than the brush method used heretofore. 3. No significant difference in the amount of bleeding after insertion could be observed between the two methods. 4. In patients with bleeding in the endometrium and pyometra it is easier to obtain specimens from the endometrium with the Endocyte than by aspiration. 5. With the Endocyte contamination of the cells of the cervix was less than after aspiration. 6. Although pain during collection of cells with the Endocyte was somewhat stronger than during aspiration, analgesics were not necessary in any one of the cases. 7. The Endocyte was used on 13 patients with endometrial carcinoma, and all specimens were positive for carcinoma. From the results of our study we conclude that for endometrial cytology the Endocyte is as useful as the aspiration method. Furthermore, it should pose no difficulty to the gynecologists to use the Endocyte because the Endocyte resembles IUD structurally.
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PMID:[Endometrial cytology by endocyte and by Masubuchi's aspiration technic --a comparative study--]. 717 79


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