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

Tamoxifen (ICI46,474) is a competitive inhibitor of estrogen action which has found ubiquitous application in the treatment of breast cancer. The drug is the front line endocrine therapy for breast cancer and is the proven treatment of choice for the adjuvant therapy of postmenopausal women with node-positive disease. Tamoxifen is available for the treatment of premenopausal patients with advanced disease, and is being evaluated in clinical trials as an adjuvant therapy for premenopausal patients with either node-positive or node-negative disease. Laboratory studies demonstrate that tamoxifen is a tumoristatic agent and long-term treatment strategies (chemosuppression) should be considered to apply the antiestrogen to its maximal therapeutic advantage. Optimal therapy with tamoxifen may also be achieved by treatment strategies to lower circulating estrogen levels in the premenopausal patient. Tamoxifen is a well tolerated drug, and long-term therapy does not appear to induce metabolic tolerance. Concerns about premature osteoporosis or cardiovascular disease appear to be unfounded because tamoxifen has an appropriate level of target site-directed estrogenic activity. Isolated reports about the growth or appearance of endometrial carcinoma during long-term adjuvant tamoxifen therapy must be balanced against the risks of withholding treatment to patients with a fatal disease.
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PMID:Long-term adjuvant tamoxifen therapy for breast cancer. 219 41

Estrogen replacement therapy is the most effective single means of preventing and treating osteoporosis. The most common objection by patients, the resumption of menses if the uterus is present, may be eliminated by providing estrogen and progestin continuously. An additional concern, endometrial carcinoma, appears to be largely alleviated by coadministration of progestin. Evidence indicates that concomitant progestin administration actually reduces the incidence of endometrial carcinoma to less than that in untreated women. An incidental but potentially more important benefit is protection against coronary artery disease. Optimal management includes initiation of estrogen therapy shortly after menopause, long-term continuation and calcium supplementation.
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PMID:Estrogen replacement therapy for the prevention of osteoporosis. 267 51

One hundred fifty-two patients with stage I, grades 2 and 3 adenocarcinoma of the endometrium, treated in 1972 and 1973 at the Radiumhemmet, are presented. Two uterine packings followed at 4 to 6 weeks by total abdominal hysterectomy and bilateral salpingo-oophorectomy resulted in a 5-year survival of 89%, whereas patients treated primarily with surgery followed by vaginal cylinder irradiation demonstrated 90% survival. Patients in both groups received whole pelvis irradiation postoperatively for deep myometrial invasion (more than 50% invasion by viable tumor). Patients treated with radiation therapy alone had 57% survival. Optimal results in poorly differentiated (grade 3) carcinoma of the endometrium were achieved with preoperative packings (90% survival); only 12% of the patients required external radiation therapy postoperatively.
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PMID:Adjunctive radiation therapy in the management of stage I cancer of the endometrium. 730 Dec 35

The incidence of coronary heart disease (CHD) rises after menopause. Hormonal replacement therapy (HRT) reduces cardiovascular morbidity and mortality. Plasma lipoproteins are modified by oral estrogen treatment: LDL are lowered while HDL and VLDL are augmented. The cardioprotective effect of oral HRT may be partially due to the reduction in the LDL/HDL ratio. Optimal changes in lipid profile are achieved with doses that usually prevent bone mass loss. Progestogens tend to blunt the increment of HDL induced by estrogens, but this depends on the type of agent and its dose. Unlike oral estrogen, HRT by the transdermal route does not always modify the lipid profile. When it does, changes are similar to those observed under the oral route in that the LDL/HDL ratio is diminished, but VLDL do not rise. Possible explanations for this discrepancy are discussed. At present there is no clear evidence that combined estrogen/progestogen treatment or transdermal estrogen alone could reduce CHD's incidence. Women with an intact uterus should receive a progestogen in addition to estrogen for prevention of endometrial carcinoma. Estrogen alone is preferable for hysterectomized women. When beneficial and adverse effects of HRT are considered simultaneously, the overall result is considered favorable, principally as a consequence of its cardioprotective properties.
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PMID:[Postmenopause, plasma lipoproteins, and hormone replacement therapy]. 820 20

High-risk endometrial cancer comprises an uncommon group of tumors, which includes pathological stage III adenocarcinoma and all stages of papillary serous carcinoma. Optimal management of this class of malignant female genital neoplasms is surgical resection, including debulking of any gross abdominopelvic disease. This article analyzes the literature concerning the use of adjunctive radiotherapy. The data presented suggest that postoperative whole abdominal radiotherapy may improve outcome in selected subsets of patients within this high-risk group. Future clinical investigations will greatly benefit from the anticipated published results of two completed prospective cooperative group clinical trials that involve whole abdominal irradiation.
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PMID:The role of radiotherapy for high-risk endometrial cancer. 1067 54

More than 50 years ago, endometrial cancer was found to be sensitive to radiation, and adjuvant radiation was observed to decrease the incidence of pelvic recurrences. Over the last 2 decades, substantial progress has been made in the understanding of prognostic factors for survival and patterns of disease recurrence for patients with endometrial cancer. Few randomized trials have been done because of the relatively few patients who are at risk of recurrence and the strong bias of many oncologists toward the use of adjuvant radiation. Principles guiding treatment recommendations are based predominately on retrospective publications containing variance in pathological evaluation, surgical evaluation, and patient selection. Preliminary analysis of a randomized Gynecologic Oncology Group trial is reviewed. Optimal therapy for many patients remains to be better defined.
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PMID:Tailoring radiation to the extent of disease for uterine-confined endometrial cancer. 1067 56

The purpose of this study was to detect possible survival advantages of surgical cytoreduction and different adjuvant treatment regimens for stage IVB endometrial cancer patients, and also to evaluate the prognostic importance of surgico-pathological risk factors and surgical morbidity rates. Thirty-seven FIGO stage IVB endometrial cancer patients treated at the Hacettepe University Hospital between 1977 and 1998 were included in this study. Clinical data were obtained from the private oncology files and all specimens were re-evaluated by the co-author pathologist. Optimal cytoreduction was defined as a surgical procedure leaving the patient with < or =1 cm residual disease in maximal diameter. All patients were subjected to initial cytoreductive surgery, but it had been achieved for 22 (60%) patients. Fourteen (38%) patients received both radiotherapy and chemotherapy, 10 (27%) patients received only radiotherapy and the other 10 (27%) patients received only chemotherapy. Three patients refused any type of adjuvant therapy. The median survival of the suboptimally cytoreduced patients was 10 months, while the median survival in the optimal group was 25 months (P = 0.001). In optimal cytoreduction group, the median survival for 12 (55%) patients without visible tumor was 48 months compared to 13 months in 10 (45%) patients with visible tumor. As an adjuvant treatment, concomitant cisplatin and radiotherapy revealed 54 months median survival compared to 15 and 13 months in patients treated with only radiotherapy and only chemotherapy, respectively. By univariate analysis, extra-abdominal metastases, suboptimal cytoreduction, visible tumoral mass after cytoreduction, pelvic-para-aortic lymphatic metastases, and cervical invasion were found to be significant predictors of poor survival. In multivariate analysis, optimal cytoreduction, concomitant cisplatin-radiotherapy treatment, and extra-abdominal metastases were significant. Morbidity was mild in six (16%), and severe in nine (24%) patients. We conclude that optimal cytoreduction achieved significant survival benefit for stage IVB endometrial cancer patients with a reasonable surgical morbidity rate. As an adjuvant treatment, concomitant cisplatin and radiotherapy was the best choice.
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PMID:The influence of cytoreductive surgery on survival and morbidity in stage IVB endometrial cancer. 1236 61

The treatment of patients with endometrial cancer is rapidly evolving. Literature data give more information on prognostic factors, allowing treatment stratification. If treatment has become less heavy in early-stage disease, therapeutic approaches have become more aggressive in more advanced disease. In this situation, treatment combines external irradiation and chemotherapy. Despite these advances, numerous questions remain on the best therapeutic sequence. Optimal chemotherapy regimens remain to be determined. On-going randomized trials will help to answer these questions.
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PMID:[Adjuvant therapy and role of radiation therapy in advanced endometrial cancers]. 1876 Jun 53

Endometrial cancer is the most frequent cancer of female genital tract. Metro- and menorrhagia or postmenopausal bleeding results in its early presentation. It allows radical treatment. However, controversies remain on surgery coverage or adjuvant therapies in early endometrial women cancer. Optimal management should minimize intervention instead of aggressive approach, as showed by recent studies. There is a role for brachytherapy as an adjuvant irradiation. Crucial publications including PORTEC-1, GOG 99, MRC ASTEC, ASTEC/EN.5, PORTEC-2 or Italian lymphadenectomy trial are discussed. Moreover, there is attention paid on adjuvant vaginal brachytherapy analyses for the past fifteen years.
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PMID:Adjuvant vaginal brachytherapy as a part of management in early endometrial cancer. 2337 55

Cervical cancer can be greatly prevented by the active search for precancerous lesions, by the effective screening. The DNA detection of high-risk human papillomavirus seems to be suitable primary screening tool, more effective than smear for cervical cytology. Organised mass screening for endometrial cancer is not held. The reason is very low prevalence of atypical hyperplasia and endometrial carcinoma in asymptomatic women and relatively low mortality rate, which is not influenced by the detection in asymptomatic stage. It is advisible to instruct all women to seek the gynecologist immediately in case of abnormal uterine bleeding and to emphasize the health education in population. Optimal protocol of the screening for hereditary endometrial malignities is debated currently. There is no effective screening for ovarian cancer in general population. Firstly, the global prevalence of the disease is low. Secondly, there is no screening modality to detect precursor lesions of the majority of malignant ovarian tumors (type II). Different strategies are tested as screening for hereditary ovarian cancer, but they cannot alternate profylactic surgery (bilateral salpingo-oophorectomy).
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PMID:[The importance of screening in oncogynecology]. 2558 58


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