Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0476089 (endometrial cancer)
 11,379 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Epidemiological studies of oral contraceptives pertaining to premenopausal women are briefly reviewed. Therapeutic considerations are noted. The clinical effects of aging and hormone replacement therapy are indicated in terms of metabolism, the endometrium, and bone mass. The pharmacological advantages and consequences of nonhormonal and hormonal contraception are explored. For aging women over 40, there is a need for relief of menopausal symptoms, contraception, and reduction of risks for atherosclerosis, hypertension, coronary heart disease, endometrial carcinoma, breast cancer, and osteoporosis. With the availability and use of low estrogen products, women over 40 can insure tissue support and prevent bone loss as long as the therapy is instituted within 3 years of the last menses. Over-40 women who drink and smoke should not use oral contraceptives. Sterilization does not satisfy longterm hormonal needs, and has other reported menstrual side effects. The dose and duration regimen of hormonal therapy must be carefully considered due to the effects on the endometrium., the coagulation system, the liver, lipids, and bone. Combination estrogen and progestogen is necessary, but consideration must be given to existing levels of endogenous hormones. Lipid patterns may change due to hormone replacement or as a result of aging and contribute to coronary heart disease. Hormone replacement can reverse the atherogenic pattern of increased low density lipoprotein levels and decreased high density lipoprotein levels; a chart gives the effects on lipids and coagulation from various estrogen or estrogen plus progestogen products. For the estrogen-deficient menopausal woman, high estrogen can decrease antithrombin III plasminogen and alpha-antitrypsin antigen levels. Lower dose progestogens are recommended. Studies of dose and effects on bone mass are reviewed and vaginal rings and transdermal steroid patches, triphasic formulations, and new progestational agents such as 19-nortestosterone derivatives are described. Newer low dose formulations are needed for the aging woman, as well as further research on what product best suits the variability of women aged 40-50
 ...
PMID:Contraception for the perimenopausal patient. 330 20

This editorial consists of summaries of the discussions on incidence, pathogenesis, prognosis and patient follow-up, and transcripts of the discussions on detection and treatment of endometrial carcinoma, from a symposium held in Carefree, Arizona. 75% of the cancers occur in postmenopausal women; average age is 52 years, but is decreasing. Endometrial carcinoma rose from 20.3 to 46.3% of all uterine cancers in Cleveland University Hospitals from 1941-1970. Older patients are often diabetic, overweight, nulliparous, with anovulatory or familial history; young women frequently resemble mild Stein-Levinthal syndrome. Clinically, 20% of patients are assymptomatic, others may have softer or larger uterus, larger ovaries, irregular postmenopausal bleeding, or lengthy onset of menopause. The Gravlee jet wash is indicated for high risk patients and those about to take estrogen. Endometrial carcinoma first affects epithelium, then endometrial stroma, then upper myometrium, lower myometrium, then other organs, perhaps via lymphatics, vagina, tubes, but ascites is uncommon. Generally, U.S. physicians use intrauterine radium followed by surgery, British use surgery first, and Swedish use radiation only. Cases must be treated individually, e.g. surgery only for minimal cancer, radium and surgery for more serious cases, and preoperative external radiation also for advanced disease. Although radiation lessens chance of implantation during surgical trauma, insertion of intrauterine radium enhances spread of tumor cells. Injectable progestins sometimes control metastatic disease, although they require 8 weeks to act. Progestins may help those with late recurrence, squamous metaplasia, or who are under 50 years of age. Estrogens are rarely effective. Prognois for terminal patients often includes subjective improvement, bowel obstruction, lung complications, hemorrhage. Radiation side effects and menopausal symptoms are often problems for cured patients. In young cured patients the endometrium should be suppressed with progestins or oral contraceptives.
 ...
PMID:Endometrial cancer: rising incidence, detection and treatment. 469 33

A physician survey was conducted in 13 counties surrounding Albany and Syracuse, N.Y., to determine estrogen prescribing patterns for treatment of problems associated with menopause. A case history of a 51-year-old woman was included in questionnaires sent to the physicians, who were asked how they would treat her in 1981 and how they would have treated her in 1974. Of the 717 questionnaires mailed to gynecologists, internists, and family practitioners, 584 were returned, a response rate of 81 percent. When asked how they would treat the woman, who was described as having frequent, severe hot flashes and other menopausal symptoms, 65 percent of the physicians practicing in both 1974 and 1981 would prescribe estrogen for the patient in 1981; 82 percent would have done so in 1974. Although 87 percent of the gynecologists would have prescribed estrogen both years, the gynecologists surveyed would have decreased daily estrogen doses of 1.25 mg by 72 percent and increased daily doses of .625 mg and .3 mg by 68 percent. Overall, 19 percent of the physicians surveyed would prescribe a daily estrogen dose of 1.25 mg or more for more than 6 months or .625 mg daily for 3 or more years in 1981, compared with 48 percent in 1974. These results suggest that many physicians have responded to the increasing evidence in the literature of a link between using estrogen to treat menopausal symptoms and endometrial cancer by switching from high doses of estrogen for long durations to smaller doses for shorter durations. Many physicians are also simply prescribing estrogens for fewer patients.
 ...
PMID:Prescribing estrogen during menopause: physician survey of practices in 1974 and 1981. 643 92

A double-blind cross-over study was performed on 21 patients treated for endometrial carcinomas who had severe menopausal symptoms. The patients were randomized into two groups and received medroxyprogesterone acetate (MPA) 100 mg twice daily per os for 12 weeks and a placebo for 12 weeks. A significantly better effect on hot flushes and sweating was obtained with MPA than with the placebo. On average the maximum effect was achieved by MPA after 4-6 weeks. Six patients had a weight gain of more than 3 kg during the MPA administration, compared with none during the placebo administration. No significant difference was found in the blood pressure increase above 160/90 mmHg between MPA and placebo groups. Patients with endometrial carcinoma may risk exacerbation of their disease by undergoing therapy with exogenous estrogen. In contrast, MPA has been found of value in the treatment of disseminated endometrial carcinomas. In this study oral MPA was effective in the treatment of vasomotor menopausal symptoms and may be an alternative in women for whom estrogens might be hazardous.
 ...
PMID:Effect of oral medroxyprogesterone acetate on menopausal symptoms in patients with endometrial carcinoma. 676 Jun 53

The cost effectiveness of estrogen use in postmenopausal women was analyzed with use of data from the medical and epidemiologic literature. Risks of endometrial cancer, uterine bleeding, and gallbladder disease were weighed against benefits associated with relief of menopausal symptoms and with prevention of osteoporosis and consequent fractures. Net effects on life expectancy are probably small in either direction, although they are likely to be positive in women with existing osteoporosis or prior hysterectomy. Treatment appears to be relatively cost effective in menopausal women with prior hysterectomy or osteoporosis but does not appear to be cost effective as a prophylactiv measure in asymptomatic women with intact uteri. For women with menopausal symptoms and intact uteri, the decision to prescribe estrogens for the individual patient and the cost effectiveness of estrogen use at the societal level depend critically on the subjective values assigned to symptomatic relief.
 ...
PMID:Estrogen use in postmenopausal women--costs, risks, and benefits. 677 Feb 70

This review of the connection between unopposed estrogen therapy for climacteric symptoms and the development of endometrial hyperplasia briefly outlines the history of the association, and then concentrates on clinical classification problems which muddy the attempts to come to a clear understanding of the relationship between estrogen replacement therapy (ERT) and endometrial cancer. Little agreement exists about the definition of endometrial pathology and of the malignant potentials of different types of hyperplasia. This paper classifies 4 types of hyperplasia: 1) cystic hyperplasia, which has the risk of malignant change of less than 2%; 2) adenomatous hyperplasia, which has a risk of malignant change from 12-25%; 3) atypical hyperplasia, which has a malignancy potential of 45%; and 4) carcinoma in situ, which is malignant. The following conditions are discussed as they are associated with endometrial hyperplasia and adenocarcinoma: 1) obesity; 2) anovulation; 3) late menopause; 4) Stein-Leventhal syndrome; 5) functioning ovarian tumors; and 6) diabetes history. In addition hypertension and cancers of the breast and ovary occur more often with endometrial cancer than would be expected by chance. The remainder of the paper discusses the administration of exogenous estrogens unopposed, exogenous progestins, and their concurrent use, especially in controlling menopausal symptoms. Prevention, diagnosis, and treatment of hyperplasia are discussed. In terms of prevention, a study showed that low-dose cyclical Premarin (.625 mg) resulted in an incidence of hyperplasia of 7% and with higher doses (1.25 mg) rose to 15%. The addition of d-norgestrel for 7 days to the high dose of Premarin reduced incidences to 3%, whereas estrogen plus low-dose norethindrone resulted in 0% incidence of cystic hyperplasia. It is recommended that the unopposed use of estrogens be avoided if possible, although short-term therapy up to 6 months is probably safe. Longer term therapy must have added progestogen, and endometrial sampling in the form of Vabra curettage should be performed every year in patients taking unopposed estrogens and every 3 years in patients taking combined estrogen therapy.
 ...
PMID:Oestrogens and endometrial hyperplasia. 699 95

Treatment of menopausal symptoms with a combination of natural oestrogens (17beta-oestradiol and oestriol) and a gestagen (norethisterone acetate), given continuously without interruption, has been found to have a good effect on menopausal symptoms, at the same time as the endometrium is maintained or brought to an atrophic state. This method seems to be a new approach to oestrogenic therapy, and in spite of the inconvenience of rather frequent--though as a rule very slight--bleeding during the first months of treatment, it should be of value. After 3-4 mth of treatment bleeding practically never occurs and the endometrium almost invariably becomes completely atrophic. It would seem that this might imply a lowered risk of development of endometrial cancer. A series of 265 patients treated in accordance with this principle for up to more and than 4 yr is presented.
 ...
PMID:Continuous treatment with natural oestrogens and progestogens. A method to avoid endometrial stimulation. 702 79

The hormone dependency of endometrial cancer and the increase of its incidence seem to be generally accepted. The Authors expose the results of a four year retrospective epidemiological research aiming at verifying the possible role of menopausal estrogen assumption in the etiopathogenesis of the above mentioned disease. Two groups of post-menopausal patients were examined, who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy: 168 were endometrial cancer free, 50 were affected. The percentages of estrogen users, the exposition time and type of therapy were carefully analyzed in them. No correlation could be found between estrogen consumption, which resulted much lower than in the U.S.A., and endometrial cancer incidence. The relatively short assumption times, the different drug associations, and the hypoestrogenic origin of the most disturbing menopausal symptoms can help to explain this finding which is however, in agreement with what emerges from studies carried out in different countries by several Authors.
 ...
PMID:Estrogen therapy in menopause and endometrial cancer. 724 49

Exogenous hormones, aside from their use as a contraceptive, are prescribed for treatment of menopausal symptoms (estrogens) and endometriosis/endometrial cancer (progestogens). This has enabled investigation of certain structural differentiations which occur during carcinogenesis in the cervix. Estrogens stimulate proliferation of stratified squamous epithelium of the ectocervix, but not that of endocervical columnar epithelium. On the other hand, progestogens stimulate the columnar epithelium and reserve cells beneath it, but not the squamous epithelium. Under estrogenic stimulation, an epithelial defect developing on the external cervical surface becomes reepithelialized mainly by the stratified squamous epithelium and is covered by regenerative epithelium. Under progestogenic stimulation, regeneration of the squamous epithelium is often preceded by proliferation of reserve cell hyperplasis. All these are benign repair processes which account for the largest proportion of the reepithelialization phenomena and healing seen in cervical ectopia. The appearance of the 3rd mucosa is the last stage of the healing process; here, a layer of mature stratified squamous epithelium covers the cervical mucosa. In a small number of cases, reepithelialization is followed by the development of precancerous lesions of various grades, and the beginning of carcinogenesis. It is possible to determine the origin of the cells from the appearance of various forms of intraepithelial neoplasis (e.g., dysplasia and carcinoma in situ of the squamous cell type, mucoid dysplasia and carcinoma in situ of the reserve cell type, microcarcinoma, and adenocarcinoma of the endocervical mucosa). An etiologic link between progrestogen administration and adenocarcinoma has been suspected. The highly potent hormone norgestrel appears to be the factor in many typical hyperplasias and carcinomas.
 ...
PMID:Structural variations of cervical cancer and its precursors under the influence of exogenous hormones. 729 31

The use of estrogens in postmenopausal women has been the subject of much controversy regarding hormone formulation, dosage, use in combination with progestins, duration of treatment, and contraindications. Estrogens have been prescribed to relieve menopausal symptoms for more than three decades. The hormones reduce the gynecologic and psychologic changes associated with menopause while inhibiting bone resorption and possibly reducing the risk of cardiovascular disease. Their use however has been complicated by an increased risk of endometrial cancer and possibly breast cancer. The use of estrogens as cardioprotective agents is discussed and the clinical experiences and the possible mechanisms of action are reviewed. The clinical pharmacology of estrogens and the various formulations that are available as monotherapy or in combination with progestins will also be reviewed.
 ...
PMID:Clinical pharmacology of estrogens: cardiovascular actions and cardioprotective benefits of replacement therapy in postmenopausal women. 775 8


<< Previous 1 2 3 4 5 6 7 8 Next >>