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

Cyclically administered estrogen helps prevent and treat vasomotor symptoms and atrophic changes in the genitourinary tracts of postmenopausal women. Administering exogenous estrogen may also help prevent postmenopausal bone loss and help treat severe postmenopausal osteoporosis. Although recent studies have indicated an association between estrogen replacement therapy and endometrial carcinoma, a true cause-and-effect relationship has not been established. Thus, estrogen replacement therapy should be administered carefully, considering the risk/benefit ration for each individual, and should use the smallest dose necessary to achieve the desired effect. If irregular bleeding occurs before or during estrogen administration, a complete gynecologic examination (including a histologic examination of the endometrium) is mandatory.
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PMID:Risks and benefits of postmenopausal exogenous estrogen. 60 92

In a prospective study conducted from 1981 to 1989, concentrations of estrogen (ER) and progesterone (PR) receptors were determined by the saturation analysis of cytosols prepared from 67 samples of human endometrial tissue. Patients over 35 years of age who had come to the hospital because of irregular bleeding were included in the investigation. In the group examined it was found that 25 patients developed endometrial carcinoma, 22 hyperplasia adenomatosa and 20 patients had normal pathohistological findings. The median values of ER concentrations were 46, 99 and 31 fmol/mg of protein, with the ranges of 0-628, 0-2348 and 0-552 fmole/mg of protein in the group with normal endometrial tissue, hyperplastically transformed endometrial tissue and in the group with endometrial carcinoma, respectively. The median values of PR concentrations were 196, 307 and 96 fmol/mg of protein, with the ranges of 0-1714, 0-2402 and 0-582 fmole/mg of protein in the group with normal endometrial tissue, hyperplastically transformed endometrial tissue and in the group with endometrial carcinoma, respectively. In the group of patients with endometrial carcinoma 40% of ER+/PR+ tumors (greater than 50 fmole/mg of protein), 36% of ER-/PR-tumors, and 24% of ER-/PR+ tumors were found. The results of the median test showed that there were no statistically significant differences among ER concentrations (chi 2 = 2.822; P = 0.2439), or among PR concentrations (chi 2 = 3.582; P = 0.1668) in the groups of patients examined.
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PMID:[Levels of estrogen and progesterone receptors in premalignant and malignant states in the endometrium]. 174 74

The use of megestrol acetate in treatment of malignancy (endometrial carcinoma, ovarian cancer, prostate cancer, breast cancer, renal cell carcinoma, malignant melanoma), endometrial hyperplasia, benign prostatic hypertrophy, contraception, anorexia, cachexia and weight loss is reviewed, concluding with a toxicity profile. Megestrol acetate was introduced in 1971 for treatment of endometrial carcinoma. Megestrol acetate is probably effective in proportion to the number of cytoplasmic progesterone receptors, but it has not been tested in a Phase III trial. For ovarian cancer it has been reported to be effective in 1 trail at doses of 800 mg/day. Prostate cancer, although difficult to assess, responds to megestrol acetate at doses of 120 mg/day because of its suppression of gonadotropins, its inhibition of 5alpha-reductase and its binding to the dihydrotestosterone receptor. Megestrol acetate permits a lower dose of diethylstilbestrol, and thus lower toxicity. There is apparently a dose-response between megestrol acetate and breast cancer, along with a response dependent on the number and type of estrogen and progestin receptors. Responses are better in postmenopausal women, and additive with other agents such as tamoxifen and mitomycin C. The medium duration of effect is 6-8 months. It has no effect on renal cancer or malignant melanoma. Megestrol acetate can be considered as an effective medical alternative to surgery for endometrial hyperplasia or benign prostatic hypertrophy. As a contraceptive in inhibits sperm transport rather than ovulation, but also causes irregular bleeding. Megestrol acetate has few side effects, and has the advantage of stimulating appetite and weight gain, a benefit in cancer patients.
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PMID:Megestrol acetate: clinical experience. 247 90

Abnormal uterine bleeding occurs across the entire age spectrum. Pregnancy, infection, birth-control methods, psychogenic causes, organic pathology, endocrine disorders, blood dyscrasias, systemic diseases and dysfunctional uterine bleeding are considered in the differential diagnosis. While the historical questions are similar regardless of age, the diagnostic methods, differential diagnosis and the management plan vary within each age bracket. Pregnancy-related disorders, infection, birth-control methods and psychogenic factors are the most common etiologies in younger women, but endocrine, systemic and hematologic disorders must be considered. In the middle years, irregular bleeding frequently occurs due to perimenopausal ovarian failure. With postmenopausal bleeding, endometrial carcinoma must always be ruled out. Treatment consists of correcting the underlying disorder. If no organic cause is identified, hormonal therapy or more invasive procedures are used.
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PMID:Abnormal uterine bleeding. 265 3

Overall 1,021 patients with endometrial carcinoma were treated between 1965 and 1982 at the Department of Obstetrics and Gynecology and the Department of Radiology, Friedrich-Schiller-University, Jena. The 5-year-survival rate of all patients amounted to 63%. The 5-year-survival probability with primary surgery was 76.1%, with primary irradiation 34.4%. The frequency of risk factors in the patient group was compared with an age adjusted group of patients who underwent a D & C due to irregular bleeding of benign causes. Overweight and infertility were evaluated as significantly more frequent risk factors in cancer patients. There was no significant difference between the two groups concerning the factors hypertension, diabetes, heart-diseases, irregular bleeding and history of carcinoma in the family.
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PMID:[Results of therapy of endometrial carcinoma and analysis of risk factors in comparison with a control group]. 275 77

A clinicopathological review of 106 cases of premenopausal endometrial carcinoma has confirmed the good prognosis in such patients. Women less than 40 years old were more likely to be nulliparous, over 80 kg in weight, and to present with irregular or heavy and irregular bleeding, than women 40 years or older. Seven patients developed malignancies at other sites. A detailed pathological review of 32 cases revealed poor prognostic features in 30% of patients; corpora lutea were identified in the ovaries of 13 patients. It is suggested that factors other than anovulation are related to the development of endometrial cancer in the over 40 age group.
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PMID:Endometrial carcinoma in premenopausal women: a clinicopathological study. 397 91

During the 1950s and the 1960s several epidemiological studies of estrogens and endometrial cancer were conducted, but most are inadequate by modern standards. More satisfactory new evidence has appeared in the last 5 years. Since 1975 and mostly in North America, there have been reports of many case control studies of estrogen use and endometrial cancer covering several thousand patients with the disease. Almost all of the studies have indicated a positive association. The magnitude of the association has varied between studies, but the average estimate of relative risk for women who had taken estrogens at any time was 6:1. There is little information that distinguishes the effects of continuous from cyclic administration of estrogen, but such as there is suggests that both regimens are associated with similar risk. Endometrial cancers occurring in women using estrogens tend to be less advanced at detection and of a more favorable grade than those in other women, suggesting that tumors resulting from estrogen use may be of low malignancy. No British epidemiological studies on estrogens and endometrial cancer have been published. This is most likely because the prevalence of estrogen replacement is low and the duration of use is usually short. There is an increased risk of endometrial cancer when estrogen replacement is given after the climacteric. If the decision is made to administer estrogen and the patient has not had a hysterectomy, this is best done cyclically and combined with a progestagen in the last 7-13 days of the cycle. Any irregular bleeding should be considered as an indication for immediate curettage.
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PMID:Oestrogen replacement and endometrial cancer. A statement by the British Gynaecological Cancer Group. 611 23

The selection of contraception for women over the age of 35 presents significant problems. The popular IUD is often contraindicated on account of producing pathological cervical and/or uterine changes. In such women the suitable contraceptives are pure gestagen pills and injectables (Depo-Provera and norethindrone enanthate). Depo-Provera contains the active ingredient medroxyprogesterone acetate (DMPA), which imitates the activity of endogenic progesterone and increases the activity of 17-hydroxyprogesterone 6- or 7-fold. Its mechanism of action on the uterine epithelium consists of antiestrogenic and antiandrogenic activity. In 1995 approximately 3.5 million women were using DMPA. Its contraceptive effectiveness amounts to 0-1.2 pregnancies per 100 women in the course of 1 year. In a 1987 multi-centered trial it was observed that the use of 250 and 500 mg of DMPA every 9 months produced a higher incidence of pregnancy than the use of 150 mg every 3 months. The causes of discontinuation of DMPA use are irregular bleeding (10.5%), reduction of libido (1.6%), and weight gain (1.4%). A 1984 clinical study of 3905 women showed that 54% of them had no untoward effects while using DMPA. The frequency of development of amenorrhea with DMPA use varies from 8% to 72%. Its hematological parameters are good and some studies showed that DMPA does not increase the risk of development of cancer of the endometrium, ovaries, and cervix. A 1991 study suggests that the relative risk of breast cancer may increase after 4 years of use of DMPA in women under 35, however, according to a 1994 study, above this age the risk is minimal. DMPA use lowers the risk of endometrial cancer, and this protective effect lasts for 8 years after cessation of use. Higher doses of DMPA treat endometrial cancer. After halting DMPA use the average time for conception to occur is 5.5 months. DMPA use in the first trimester does not produce adverse effects on the newborn or on lactation.
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PMID:[Contraception with injectable long-acting preparation depo-provera]. 765 32

The aim of our study was to verify the efficacy of transvaginal ultrasound scanning as an indicator of the endometrial status in healthy menopausal women. One hundred eighty five healthy women in natural menopause were examined by vaginal sonography; the endometrial patterns were analyzed and the influence on it of body weight, menopausal age, and hormonal therapy was considered. The presence of irregular and the endometrial histology were related to the ultrasound findings. 38% of the women assumed estrogen plus progestin replacement treatment since one-two years, for menopausal complaints. 17% of all patients reported irregular bleeding during the last month. The majority of women (90%), regardless of the hormone assumption, presented en endometrial thickness less than 10 mm. 10% of untreated and treated women had an endometrial thickness between 10 and 20 mm. Among the subjects with elevated menopausal age is more frequent the imaging of endometrial layer minor than 5 mm in comparison with women in early menopause. 4% of untreated and 10% of treated women without irregular bleeding had an endometrial thickness higher than 10 mm, while 67% of women with irregular bleeding presented an endometrial layer higher than 10 mm. In treated group all women with endometrial thickness greater than 10 mm had amenorrhoea. 86% of patients had endometrial atrophy detected by biopsy; hyperplastic endometrium or endometrial cancer was not demonstrated. In conclusion, vaginal sonography is a simple and reliable method in the study of the endometrial pattern in healthy menopausal women.
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PMID:[Echographic monitoring of the endometrium with a transvaginal probe in the menopause. A clinical study of 185 women in the menopause]. 783 11

Concerns about abnormal menstrual bleeding are a common reason for women to consult a primary care physician. The first step in the evaluation is to determine the patient's ovulatory status. Women with heavy bleeding but normal ovulatory cycles should be evaluated for coagulopathies, structural lesions, and hypothyroidism. In the absence of a systemic or structural cause, menorrhagia can be treated with OCPs or NSAIDs. Intermenstrual bleeding in OCP users may be due to noncompliance or the use of low-dose pills. Encouraging patient compliance and adjustment of the estrogen dose can often solve the problem. If the patient is not on OCPs, intermenstrual bleeding is usually due to a structural or inflammatory lesion. The differential diagnosis for anovulatory bleeding is extensive. Pregnancy, systemic illnesses, and structural lesions should be ruled out by history, physical examination, and laboratory evaluation. Endometrial biopsy is indicated in patients over age 35 and younger patients with risk factors for endometrial cancer, such as chronic anovulation and obesity. Dysfunctional uterine bleeding is a nonspecific term for abnormal uterine bleeding in the absence of systemic or structural disease. It is usually associated with anovulation. Adolescents frequently have dysfunctional uterine bleeding owing to immaturity of the hypothalamic-pituitary-ovarian axis. Perimenopausal women have an increased incidence of irregular bleeding secondary to decreased estrogen production by the ovary. Obesity, polycystic ovary syndrome, stress, crash diets, and vigorous exercise can all disrupt normal ovulatory function. Treatment options for dysfunctional uterine bleeding include oral contraceptives, cyclic progesterone, or hormone replacement with estrogen and progesterone. Patients with structural lesions or those who do not resume normal withdrawal bleeding patterns on hormone therapy should be referred to a gynecologist for further evaluation and treatment.
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PMID:Abnormal uterine bleeding. 787 94


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