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

The ultimate role played by peritoneal cytologic evaluation in endometrial cancer remains somewhat ill-defined. Proper assessment of peritoneal cytology as an independent risk factor awaits a prospective study in which patients with malignant peritoneal cytology and surgical Stage I lesions are not treated and survival is compared to controls with negative cytology. Such a study is unlikely to be done, given results available from retrospective analyses and the large number of patients needed to complete such a trial. Whether therapy is needed and which type to use in patients with malignant cytology remain uncertain. Half of these patients will presumably require pelvic radiotherapy for adnexal, nodal, or other pelvic spread. Potish et al. have advocated the use of whole-abdominal radiotherapy in such patients, with favorable results. In patients without extrauterine spread, Creasman et al. have championed the postoperative use of intraperitoneal radioactive phosphate. They based their recommendation on survival results in a group of 23 patients with positive washings who were treated with intraperitoneal radioactive chromic phosphate. In this group, the recurrence rate was reduced, when compared to historic controls, to 13% (3/23), all of whom had extra-abdominal recurrences. Soper et al. confirmed the safety of postoperative radioactive chromic phosphate in doses of approximately 15 millicuries in patients with endometrial cancer. In their study of 65 patients, 56 had percutaneous catheter placement under local anesthesia after laparotomy. In one patient, the catheter could not be used because of poor distribution of the technetium Tc 99m sulfur colloid tracer, and in a second subject, fever and peritoneal signs suggesting bowel perforation led to removal of the insertion catheter. No other significant problems were encountered in 48 patients treated with radioactive chromic phosphate without other therapy. In contrast, five of seventeen patients who received external pelvic radiotherapy in addition to radioactive chromic phosphate suffered bowel complications requiring surgical intervention. Two of these patients died of operative complications, suggesting that radioactive chromic phosphate cannot be safely combined with standard dose external radiotherapy. In a retrospective series, Mazurka et al. intimated that adjunctive chemotherapy might be useful in patients with malignant cytology, but such an approach is untested. A prospective randomized study of radioactive chromic phosphate, whole abdomen radiotherapy, or adjunctive chemotherapy versus no treatment in patients with malignant peritoneal cytology is clearly needed.
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PMID:Peritoneal cytology in endometrial carcinoma. 257 1

During a period of 2 years (1981-1982), 226 outpatient endometrial aspiration curettages (EACs) were performed with a new aspiration curette that had been developed by the authors. All patients had risk for general anesthesia. From 17 of them, endometrial polyps were removed by the EAC. Endometrial carcinoma was diagnosed in eight others, adenomatous hyperplasia in four, and cystic hyperplasia in two women. The main advantage of the new curette is the ability to aspirate endometrial polyps through its modified opening.
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PMID:Outpatient diagnostic endometrial aspiration curettage with a new aspiration curette. 288 30

Many gynecologists use routine endometrial sampling prior to hysterectomy to detect an unsuspected endometrial carcinoma. Gynecologists who formerly performed uterine curettage under anesthesia before hysterectomy now often use an outpatient endometrial sampling technique. Although safe, this procedure is complicated by discomfort, cost, and the risk of infection or uterine perforation. The purpose of this study was to determine the utility of pre-hysterectomy endometrial sampling. Between 1981-1985, 619 patients undergoing hysterectomy had preoperative endometrial sampling using Vabra aspiration, the Novak curette, or D&C. The endometrial sampling histology was compared with that in the hysterectomy specimen. There were 30 instances in which the endometrial sampling failed to identify either endometrial hyperplasia or carcinoma. In the two cases of endometrial carcinoma, D&C was the sampling method used. The findings of this study indicate that these three techniques of endometrial sampling are equal in their diagnostic capabilities. The results confirm the need for biopsy in patients with postmenopausal bleeding or with abnormal uterine bleeding at age 35 years or older. Our findings do not support routine endometrial sampling prior to hysterectomy.
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PMID:Endometrial sampling prior to hysterectomy. 291 64

With respect to the most efficient approach to the diagnosis and treatment of carcinoma of the endometrium, the recognition of women at high risk can reduce this disease to a minimum and possibly eradicate much of the resulting mortality. Such an approach depends on the following factors: Recognition of the menopause as a time of life when high-risk patients may be identified. Recognition of adenomatous hyperplasia as a precursor of invasive endometrial cancer. Further research into the technology of obtaining suitable samples in menopausal women on an ambulatory basis without anesthesia is indicated as a search for efficient screening. Until such research yields new methods, however, recognition of the high-risk menopausal women through histologic sampling at menopause, with or without dysfunctional bleeding, can serve well. The modern FIGO staging formula shows the order of clinical virulence of any endometrial cancer and allows individualization of treatment in a manner that prevents overtreatment of those with less aggressive tumors and undertreatment of those with highly virulent tumors. Overtreatment causes an excess of complications, and undertreatment leads to a lower rate of cure than might be obtained by more radical treatment. Such individualization of treatment allows recognition of the appropriate place for surgical and/or radiotherapeutic treatment and the combinations that are most appropriate for the particular patient. Individualization also encourages the development of new chemotherapeutic agents and more efficient use of those now existing. Hormonal treatment is indicated for several categories of perimenopausal or postmenopausal patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Current concepts in the control of carcinoma of the endometrium. 308 46

Surgery should be an integral part of the management of the patient with endometrial cancer. Only patients with severe medical conditions should be treated with radiation therapy alone. Although radiation therapy alone often can cure endometrial cancer, five-year-survival figures are poorer than for operation. At the University of Vienna, I. Department of Gynecology, 198 patients with endometrial cancer were treated by radiation therapy alone. Using the afterloading-iridium-192-technique, the three-year-survival-rate was 76%, five-year-survival 60%. A comparable group of 185 cases treated by intracavitary radium-226 had five-year-survival of only 40% (p less than 0.001). With afterloading high-dose irradiation younger patients had five-year-survival of 75%, older patients (70 years and more) 51%; when tumor grading was one survival figures reached 76%, with tumor grading 2 and 3 only 41%. Severe radiation side effects did not occur with the optimal intrauterine single dose of 850 cGy (four times) and 700 cGy intravaginal (once), nor could any severe complications be observed when the total rectal dose did not exceed 500 cGy. In only 8% of the cases the treatment was combined with external irradiation (Cobalt-60). Intrauterine and intravaginal applications were performed without anaesthesia and the hospitalisation time was very short.
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PMID:[Treatment of inoperable endometrial carcinoma with intracavitary high-dose rate iridium irradiation]. 317 49

An analysis of 97 patients with multiple primary gynaecological neoplasms (90 double-, 6 triple- and 1 quadruple carcinomas) was done at the Gynaecological Department of the University of Innsbruck. Two thirds of the tumour combinations were located in the female genital tract including the breast. Concerning the early detection of simultaneous or subsequent malignancies of the cervix or corpus uteri, one should pay attention to the mamma being involved in the treatment or aftercare of such cancers. In the same way the inner female genital tract has to be observed in breast cancer patients. Regular colposcopic and cytological examinations of the cervical portio as well as a systematic prevention of endometrial cancer (pistolet in local anaesthesia) is highly recommended. The prognosis of the "highly malignant" tumour does not worsen as a result of a second malignant cancer.
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PMID:[Multiple cancers in gynecologic oncology]. 323 3

A new operating hysteroscopic fiberscope consisting of soft and rigid parts (4.8mm outer diameter) was developed with the support of Fuji Photo Optical Company. The working part of the scope can be divided into three sections: A flexible soft front section, a rotary rigid middle section and a flexible self retained semirigid rear section. With these functional parts the intrauterine target can be approached directly to perform the following operations. 1. Directed intrauterine biopsy. Thirty-five patients diagnosed as having endometrial polyp (13), submucous myoma (8), endometrial hyperplasia (4), endocervical polyp (3), endometrial carcinoma (2) and others (5) underwent direct biopsy with hysteroscopic control. No cervical dilatation or anesthesia was necessary. 2. Transcervical recanalization. In six cases of proximal tubal occlusion, a ureteral catheter or a percutaneous coronary balloon angiocatheter was introduced into the tubal ostium of the obstructed side to resolve the occlusion successfully with concomitant laparoscopy. 3. Hysteroscopic chorionic villus sampling. Chorionic villus sampling was performed with a ureteral catheter under direct hysteroscopic control and ultrasound guidance in eighteen pregnant women at from seven to fourteen gestational weeks. In fifteen cases, the samplings were performed satisfactory. 4. Removal of a lost IUD. Three cases of lost IUD underwent hysteroscopic removal without difficulty. Our results have proved that this scope is a very useful tool for intrauterine operations.
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PMID:[The development of a new operating hysteroscopic fiberscope and its clinical application]. 323 86

Endometrial cancer occurs more than twice as frequently as cervical cancer. The main risk factors are age, estrogen use, and obesity. Increasing life expectancy and more liberal use of estrogen to prevent postmenopausal bone loss will probably increase the magnitude of the problem. Endometrial cancer is a heterogeneous disease. Good prognosis is associated with obesity and estrogen use and with carcinomas preceded by precancerous hyperplasia. A bad prognosis may be found in women without major risk factors and is associated with a normal or atrophic endometrium. Because of a high prevalence of asymptomatic disease (6.9 per 1,000) and because the group with a poor prognosis is usually asymptomatic, all postmenopausal women should be screened at least one time. For screening, the use of one of the cytologic instruments is recommended; these instruments are safe, easy to handle, and can be used in the office setting without anesthesia. Yields are comparable to dilation and curettage. Family physicians are encouraged to familiarize themselves with cytologic instruments and to use them for screening postmenopausal women in their office.
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PMID:Detection of and screening for endometrial cancer. 327 9

Endosonography offers two major advantages in the pretherapeutic examinations of a histologically verified carcinoma of the uterus. Endosonography allows (1) an overview of the size and location of the tumour and (2) an evaluation of the spreading and/or involvement of adjacent organs. Both add up to a more objective staging of the tumour and, therefore, may cause a more effective therapeutic approach. Especially in cases with endometrial carcinoma the uterine walls can be visualized either by the well-tolerated method of vaginosonography or by hysterosonography which can be performed only in general anaesthesia. Applying either endosonographical method, the infiltration depth of the myometrium and/or involvement of the cervix can be determined, which seems to be very valuable, particularly when differentiating between stages I and II. Rectosonography, with its transversal scanning probes, offers the advantage of demonstrating the infiltration of a cervical tumour into the parametrium. Here again, the benefit is seen in a more objective evaluation of tumour size and extension. However, tumour growth into the urinary bladder is best shown by cystosongraphy. With this method one cannot only have a view of the epithelium (as in cystoscopy) but one is also able to evaluate the underlying layers of the bladder wall. This seems to be an advantage in findings of a bullous oedema. Once again, rectosonography is advantageous in enhancing the diagnosis of recurrences of malignant tumours in the pelvic region. Like a prolongation of the palpating finger rectosonography is able to depict less echogenic areas located high up on the pelvic wall as local recurrences or tumours.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Endosonographic diagnosis in uterine tumors]. 331 16

A report is given of results and complications following postoperative irradiation in endometrial carcinoma via monitored high-dose afterloading therapy (iridium 192). Intravaginal irradiation was performed in all operated cases. In advanced cases or in cases with poor prognosis (deep infiltration of the myometrium, tumour grading 1-2) percutaneous irradiation (cobalt 60) was employed additionally. 327 patients with endometrial carcinoma were treated by postoperative irradiation between 1981 to 1985 and could then be followed up for at least 12 months to 5 years. Evaluation was done with regard to recurrence-free survival rate and side effects. With the postoperative afterloading iridium 192 technique, the 3-year recurrence-free rates were 91% in stage I and 78% in advanced stages. All of the patients in stage I with a control time of 5 years survived. The incidence of radiation side effects in the overall group was: cystitis 4%, proctitis 7% and fistulas 0.6%. No further severe complications occurred with the optimal intravaginal fraction dose of 700 cGy (twice). The afterloading therapy with high dose rates and remote control monitoring reduces the risk of radiation exposure of the medical staff and also places less strain on the patients because of the short-term irradiation. Intravaginal applications were performed without anaesthesia or any drugs, and treatment on an outpatient basis was possible in almost all of the cases.
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PMID:[Afterloading short-term irradiation of the vagina following radical surgery of uterine cancer]. 364 40


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