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

A reappraisal of endometrial cancer over the past decade reveals: 1) new concepts in its pathologic nature; 2) increase in incidence; 3) acceptance of the theory of hormonal relation; and 4) acceptance of individualization of treatment. Although endometrial carcinoma is still thought of as a predominantly well-differentiated adenocarcinoma, an increase in more virulent tumors has been seen in recent years. These include: adenosquamous carcinoma; adenoacanthoma; mesodermal sarcomas; and adenometous hyperplasia. Women at high risk for these tumors include those suffering from obesity, infertility, failure of ovulation, dysfunctional uterine bleeding, and those on long-term estrogen therapy. These women can be recognized and monitored by means of endometrial biopsy of the aspiration-curettage type. Adenomatous hyperplasia, the precursor of cancer, requires treatment with progestin or hysterectomy according to patient's age and reproductive status. Estrogens should be used only when indications are clear and in the smallest possible dose for the shortest period of time until the therapeutic goal is achieved. Aggressiveness of treatment should correspond to virulence of tumor. Dilatation and curettage under anesthesia should be used for clinical staging of endometrial cancer. Other means of treating endometrial cancers' include: total hysterectomy; bilateral salpingo-oophorectomy; iliac-aortic lymphadenectomy; pelvic irradiation; radical hysterectomy; chemotherapy, and a drug regimen (including cyclophosphamide, doxorubicin, fluorouracil, megestrol acetate).
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PMID:Current concepts in cancer: The changing nature of endometrial cancer. 735 80

The advantages and problems as well as the clinical reliability of aspiration curettage of the uterus were investigated. In 15% of the 665 cases, the procedure could not be proceeded by technical reason or by insufficient material for histological diagnosis. On the other hand, diagnostic accuracy in endometrial cancer is as reliable as in conventional curettage with general anesthesia. The curettage can be performed easily with minimal costs as an outpatient procedure; this is the main advantage of aspiration curettage. (Authors' modified)
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PMID:[Aspiration curettage]. 740 9

In a 12-month period, a total of 507 diagnostic curettages were performed with manual vacuum aspiration (MVA) and sharp metallic curettage (SMC), at the Gandhi Memorial Hospital (GMH). Of these, 406(80.1%) and 101(19.9%) were managed with MVA and SMC, respectively. The bulk of the study population were married, of urban residence, paying and treated on ambulatory basis in the minor operation theater without anaesthesia and analgesia. There were significant differences in the gravidity, parity and abortion frequency of the groups (P < 0.05). The mean ages for MVA and SMC were 35.9 years +/- SD 7.6 years and 36.5 years +/- SD 8.5, years respectively (P < 0.05). The majority of the study population that were subjected for histopathological evaluation of the corpus uteri were in the age group of 35-39 years and accounted for 137 (27.0%) with a cumulative frequency of 66.1%. The service providers handled most of the cases with MVA (P > 0.05) and the indications were mainly for abnormal uterine bleeding and endometrial dating. The histological yields were 97.0% for MVA and 80.2% for SMC. The adequacy of the specimen for MVA and SMC were 0.95 and 0.78, respectively. Even if inadequate and non-conclusive are merged together, the adequacy of the specimen would still be 0.91 and 0.74 for MVA and SMC respectively, maintaining the same proportion. Coincidentally, the diagnostic accuracy for endometrial polyp and also for endometrial carcinoma were 0.7 for MVA and 0.3 for SMC. Our results are similar to that of other researchers.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Trends in the evaluation of abnormal uterine bleedings with the introduction of manual vacuum aspiration. 749 49

The authors anesthetized a 48-year-old woman with endometrial cancer and a large ovarian cyst. She developed cardiac failure initially followed by the sick sinus syndrome and A-V block from hypertrophic cardiomyopathy, prior to neuromuscular symptoms. Epidural anesthesia assisted by general anesthesia was carried out safely without intravenous administration of any muscle relaxants. From this experience, it is considered that epidural anesthesia assisted with some other proper methods is suitable for surgery of lower abdomen.
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PMID:[Perioperative management of a patient with myotonic dystrophy developing the cardiac symptoms initially prior to the neuromuscular symptoms]. 793 10

Between January 1988 and April 1991, 57 patients with advanced gynecologic carcinoma were preoperatively evaluated by gynecologic examination and endosonography (ESG) using general anesthesia. Abdominopelvic computed tomography (CT) was performed in 49 patients and magnetic resonance imaging (MRI) in 21 patients. There were 34 primary tumors and 23 instances of recurrence. Causes of gynecologic carcinoma were 38 carcinomas of the cervix uteri (26 primary and 12 recurrences), eight carcinomas of the ovary (four primary and four recurrences), three recurrences of carcinoma of the endometrium, five sarcomas of the uterus (one primary and four recurrences) and three primary carcinomas of the vagina. All of the patients were operated upon. This perspective study compares the data from clinical and imaging examinations to the data obtained from histologic examination of surgical sections. According to anterior or posterior tumor extension, the accuracy of clinical evaluation and preoperative imaging were studied for the posterior vesical wall and the vesicovaginal septum and the anterior rectal wall and the rectovaginal septum. Histologic examination revealed vesical involvement in 17 patients and of the involvement of vesicovaginal septum in 21 patients. The accuracy of the clinical examination, ESG, cystoscopy, CT and MRI was 83, 88, 87, 75 and 81 percent, respectively, for vesical extension. Cystoscopy was not taken into account for evaluation of extension to the vesicovaginal septum--accuracy was 80, 90, 67 and 86 percent for clinical examination, ESG, CT and MRI. Histologic examination showed involvement in the rectum in 14 patients and involvement in the rectovaginal septum in 19 patients. Rectoscopy was performed 13 times. The accuracy of clinical examination, ESG, CT and MRI was 91, 98, 89 and 71 percent, respectively, for extension to the anterior rectal wall. Rectoscopy was not taken into account for evaluation of extension to the rectovaginal septum--accuracy was 80, 96, 75 and 57 percent for clinical examination, ESG, CT and MRI. Endosonography would seem to be useful to complete examinations for regional extension of advanced gynecologic carcinomas. Its accuracy is superior to that of other examinations. Because it is performed using general anesthesia, there is no discomfort for the patient during this low cost procedure.
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PMID:Results of a prospective study with comparison of clinical, endosonographic, computed tomography, magnetic resonance imaging and pathologic staging of advanced gynecologic carcinoma and recurrence. 835 95

Between 1984 and 1992, 27 patients with clinical stage I-II histologically proven adenocarcinoma of the endometrium who had significant medical risks precluding surgery underwent radiotherapy (RT) as the primary treatment. The median age at diagnosis was 74 years. There were 20 patients (74%) with stage I and 7 patients (26%) with stage II disease. Patients were treated with high-dose-rate brachytherapy (HDRB) alone (19/27) or with a combination of external-beam RT and HDRB (2 stage I; 6 stage II). HDRB was delivered using a cobalt-60 HDR remote afterloading unit, with a median dose of 2000 cGy to point A, in two to three fractions given once a week. All HDRB treatments were performed under spinal anesthesia on an outpatient basis. External-beam irradiation to the pelvis was given using 4- to 6-MV photons and a median dose of 4200 cGy was delivered. In all patients, vaginal bleeding was controlled within a few days after completion of RT. With a median follow-up of 47 months, the 8-year disease-specific survival rate was 76%. Patients with stage I had an 8-year survival rate superior to that of patients with stage II (95% vs 21%, P < 0.001). No complications were experienced during HDRB. Late serious complications were seen in 3 patients (11%). Based on this retrospective review, primary RT with HDRB appears to be an effective and safe treatment for those patients with medically inoperable clinical stage I endometrial carcinoma. Because HDRB is given on an outpatient basis, it is an attractive option for these patients. However, in stage II disease the results of treatment are poor and RT alone should be considered only when the surgical risks are too high.
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PMID:High-dose-rate brachytherapy as the primary treatment of medically inoperable stage I-II endometrial carcinoma. 852 57

Three hundred twenty-five postmenopausal women with abnormal uterine bleeding had transvaginal ultrasound examinations. In 158 the endometrial thickness was greater than 5 mm, in 20 less than 5 mm but irregular, and in 147 less than 5 mm and regular. Diagnostic hysteroscopy was performed in the first two groups and showed mild endometrial abnormalities in 23 women, severe in 23, endometrial polyps in 55, myoma in 10, and normal endometrium (atrophic or proliferative) in 22, with synechiae in 5. Forty-six (32%) endometrial biopsies were performed and showed 20 adenocarcinomas, 3 atypical hyperplasias, 10 simple hyperplasias, 5 atrophies, and 8 proliferative. In 18 patients the examination was not possible because of cervical stenosis and was performed under general anesthesia; polyps were removed by operative hysteroscopy. In patients with endometrial thickness greater than 5 mm, hysteroscopy revealed only two cases of mild endometrial abnormalities (cystic atrophy), two polyps, and two myomas. The frequency of endometrial cancer was 7%, similar to that reported by others. Ultrasonography is sensitive in evaluating abnormal uterine bleeding with or without endometrial pathology. Hysteroscopy must be the second procedure because it can exclude pathology and allow a targeted biopsy to confirm the diagnosis.
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PMID:Vaginal Ultrasonography and Diagnostic Hysteroscopy for Women with Abnormal Uterine Bleeding after Menopause 907 54

Six hundred and six diagnostic hysteroscopies were conducted between April of 1991 and November of 1994 and retrospectively analysed; 544 of these were made in routine outpatient clinic with paracervical anaesthesia in 438 (72%) of the cases. Mean hospitalisation was for a period of six hours. The patient's mean age was 48.7 years and the most frequent indications were, abnormal uterine bleeding (220 cases-35%) and post menopausal metrorrhagia (176 cases-29%). Our cases showed a morbidity rate of 1.9%. We found a positive correlation between the hysteroscopic findings and the histological study in 428 examinations (71%). The hysteroscopic procedure allowed us to make a precise and early diagnosis of many gynecologic pathologies, a proper therapeutical approach and provided an endometrial cancer screening tool. These aspects are very important in our region because our female population some risk factors for that endometrial cancerous or precancerous lesions.
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PMID:[Diagnostic hysteroscopy]. 947 91

In some countries, the incidence of obesity doubles every 10 years. For the obstetrician-gynecologist, there are many different situations where the patient's excess body weight calls for an adapted diagnostic and therapeutic approach. Obesity does not in itself appear to be a factor lowering fertility. However obesity-induced hormone disorders could contribute, in certain cases, to biological imbalance and thus favor the development of ovulation dysfunction. Pregnancy in obese women should be managed as a high risk pregnancy. The incidence of gestational diabetes and hypertension is increased. Macrosomatia is frequent. There is a 2- to 3-fold increase in the rate of cesarean sections with more complications. Fetal morbidity does not appear to be changed when maternal weight gain is limited. With obesity, there is an increased risk for breast and endometrial cancer due, for most authors, to elevated levels of circulating estrogens resulting from aromatization of male sex steroids in adipose tissue and decreased levels of sex hormone-binding globulin. Anesthesia and surgery in obese patients can be problematic and special care must be taken to prevent further morbidity. Laparoscopic surgery is possible under certain conditions, although its role remains to be determined. Prescription of hormone replacement must take into consideration several parameters which determine its usefulness and surveillance. Obesity is not a contraindication for hormone replacement therapy but is frequently a non-indication.
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PMID:Obesity in obstetrics and gynaecology. 957 82

The aim of this study is to analyse the histopathologic findings from the uterine cavity and the cervical canal among women who attended the gynecologic clinic of HMI Pleven for abnormal uterine bleeding. The study is retrospective and for a ten month period--from 01.03, 1996 to 31.12, 1996. After dilation and curettage under general anaesthesia histologic examination of the material was done in 161 women aged 19 to 73 years. The patients were divided according to the pathomorphologic findings from the uterine cavity into 9 groups and into 5--according to the findings from the cervical canal. The analysis of the data shows that the peak of abnormal uterine bleeding is 48 years, and that of endometrial carcinoma--51 years. The relative ratio of pathologic findings from the uterine cavity, including endometrial polyps, simple, adenomatous and atypical hyperplasia and carcinoma of the endometrium is 47.2%.
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PMID:[Dilatation and curettage in women with abnormal uterine bleeding--an analysis of the histopathological findings]. 977 Jul 96


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