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

Mortality is the greatest concern in assessing risks of modern reversible contraception. The problems identified with older oral contraceptives (OCs) have decreased with the lower doses in current OCs. These problems include cardiovascular and thrombotic effects, changes in lipid metabolism, breast cancer, liver cancer, increased risk of chlamydia cervicitis, no protection against sexually transmitted diseases (STDs) and HIV, and interferes with breast feeding. On the other hand, OCs protect against anemia, menstrual disorders, ectopic pregnancy, acute pelvic inflammatory disease (PID), and ovarian and endometrial cancer. Since the contraceptive implant, Norplant, has no estrogens, it does not have the cardiovascular risks associated with OCs. Possible risks from Norplant use include changes in carbohydrate, liver, and lipid metabolism but they tend to be clinically insignificant and no protection against STDs/HIV. Menstruation disorders are the major side effect. Apparent benefits of Norplant are protection against anemia and ectopic pregnancy and no effect on lactation. The injectable contraceptive, Depo-Provera, causes menstrual changes, may slightly increase the risk of breast cancer, may decrease bone density, and does not protect against STDs/HIV. It protects against endometrial cancer. It has no effect on metabolism. Risks associated with the IUD include PID, perforation, anemia, increased menstrual bleeding, and pregnancy. IUDs do not affect the quantity of composition of breast milk. They are best suited for women in a mutually monogamous, long-term relationship. Barrier methods provide some degree of protection against STDs/HIV and PID. Condoms provide the most protection. They do not affect lactation. Their major complications are contraceptive failure and risks associated with pregnancy. For all women, especially those in high risk categories, one must balance the risks of modern contraceptive use with the risks of childbearing and with their benefits.
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PMID:The safety of modern contraceptives. 784 6

Endometrial hyperplasia was proposed as a predecessor to endometrial carcinoma already at the end of the 19th century. However, there have been different opinions regarding this view. The treatment also varies, but generally cyclic progesterone at a dose of 10 mg a day is used. In order to investigate whether endometrial hyperplasia is a premalignant state and also whether a high-dose gestagen treatment would cure a high proportion of these patients, a prospective randomised study was started in 1982. We now present the 5 year follow-up consisting of 82 patients treated with high-dose gestagen. In this study 19 out of 82 patients had hysterectomies (2 due to hyperplasia and 11 due to bleeding), almost the same frequency as in a previous report with patients followed-up with abrasio only, but now mainly due to bleeding problems. In summary, no carcinoma developed and the hyperplasia was cured with 500 mg MPA i.m. twice weekly for three months. However, the bleeding problems, though almost always only spotting, remained, leading to a frequency of hysterectomy that was still too high. We find latter clinical problem an enigma. Further studies are therefore in progress in our group which try to identify other treatment modalities for those patients with bleeding problems or who redeveloped hyperplasia after abrasio, in order to avoid hysterectomies.
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PMID:Spontaneous endometrial hyperplasia. A 5 year follow-up of 82 patients after high-dose gestagen treatment. 787 26

Hormonal agents have been used to treat endometrial cancer since the early 1960s. The response rate for patients with advanced or recurrent endometrial cancer subjected to gestagen therapy has been reported to be about 30%. However, the analysis of the action mechanism of gestagen on endometrial cancer is not complete. Since oral administration of high dose MPA has begun, thrombosis has been reported as an uncommon but severe side effect. The risk factors for thrombosis in patients having gestagen therapy were clarified in the report published by the Ministry of Welfare in 1992. This report emphasized the importance of patient selection for gestagen therapy and cautious management. Besides gestagen therapy, antiestrogen therapy has been tried for the treatment of endometrial cancer. However, tamoxifen therapy was not so effective compared with gestagen. Moreover, antiestrogen-gestagen combination therapy and chemo-endocrine therapy are on trial recently. These trials are attempts to find a more effective regimen for the treatment of endometrial cancer. A recent theme in the study of hormonal therapy is basic investigation concerning the effect of MPA upon the action of growth factor and oncogene expression in endometrial cancer cells. These studies may lead to a molecular biological explanation of the action mechanism of gestagen therapy in future.
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PMID:[Hormonal therapy in endometrial cancer]. 825 43

Currently, more than 50% of married women of childbearing age are using a form of contraception. Between 1960-65 and 1985-90, the number of contraceptive users in all developing countries increased from 31 to 381 million, in East Asia from 18 to 217 million, in Latin America from 4 to 44 million, in South Asia from 8 to 94 million, and in Africa from 2 to 18 million. WHO has recently estimated that over 500,000 women die each year from causes related to pregnancy and childbirth. With a worldwide estimate of 36-53 million induced abortions performed each year, between 125,000 and 170,000 women die each year because of unsafe abortions. According to data from the World Fertility Survey, short spacing between births raises the average chances of offspring dying in infancy by 60-70% and the chances of dying before the age of 5 years by about 50%. WHO's minimal estimate for yearly incidence of bacterial and viral STDs (excluding HIV infection) is 130 million. Most STDs have more serious sequelae in women than in men and lead to pelvic inflammatory disease (PID), permanent infertility, and the risk of ectopic pregnancy. African countries with high incidence of STDs have the lowest prevalences of contraceptive use. A recent examination of the WHO international data base of 22,908 IUD insertions and 51,399 woman-years of follow-up indicates that the occurrence of PID in IUD users is most strongly related to the insertion process and to background STD risk and suggests that PID is an infrequent occurrence after the insertion period. A WHO Scientific Working Group review confirmed the beneficial effects of oral contraceptives in reducing the risk of ovarian cancer, endometrial cancer, and biopsy-proven benign breast diseases. A WHO collaborative study in 5 centers in Kenya, Mexico, and Thailand provided assurance that women who used DMPA for a long time and who initiated use many years previously are not at increased risk of breast cancer.
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PMID:Contraception and women's health. 832 13

Combination oral contraceptive (COC) users have reduced risks of ovarian and endometrial cancer, but COCs have not reduced breast cancer risk. We have previously argued that a hormonal contraceptive with substantially lower doses of sex-steroids should reduce breast cancer risk by decreasing the breast epithelial cell proliferation below usual premenopausal levels. We report here the preliminary results of a pilot trial with such a prototype contraceptive consisting of an agonist of gonadotropin releasing hormone (GnRHA) administered with low doses of an oral estrogen (0.625 mg of conjugated estrogen, CE, for 6 days every week) and intermittent oral progestogen (10 mg of medroxyprogesterone acetate, MPA, for 13 days every 4 months). Eighteen subjects at five-fold or greater increased breast cancer risk were entered and randomized -12 to the contraceptive arm and 6 to a control arm. The principal endpoints included tolerance of the regimen, vaginal bleeding patterns, and the regimen's effect on the endometrium, bone metabolism, and lipids. A symptom questionnaire was used to assess tolerance; the contraceptive subjects had fewer symptoms following initiation of the regimen. This results from the elimination of symptoms associated with the luteal phase of the menstrual cycle, commonly referred to collectively as premenstrual syndrome, PMS. The few occurrences of hot flushes or vaginal dryness that did occur were eliminated by small increases in estrogen dose (0.9 mg CE). Scheduled vaginal bleeding occurred associated with most periods of progestogen administration. Unscheduled bleeding or spotting was infrequent and decreased with time on the regimen. A beneficial rise in high-density lipoprotein cholesterol was evident in the contraceptive subjects. Despite the use of an estrogen dose which is known to prevent loss of bone mineral density in normal postmenopausal women, an annualized loss of 1.9% was seen in contraceptive subjects. It is hypothesized that this is secondary to inhibition of ovarian androgen production by the GnRHA, which may additionally account for changes in libido occasionally reported with GnRHA. The study continues with the addition of a small dose of androgen to replace that lost by the action of the GnRHA.
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PMID:Pilot trial of a gonadotropin hormone agonist with replacement hormones as a prototype contraceptive to prevent breast cancer. 839 Mar 40

The major complaint about injectable hormonal contraceptives, e.g., Depo-Provera (DMPA), is changes in menstrual patterns. In fact, menstrual alterations are the leading reasons women opt to discontinue their use. Injectables' ability to suppress ovulation over a long period and to cause extended endometrial atrophy can delay a return to fertility. Prior to 1967, clinicians used DMPA to treat endometrial cancer. In 1967, its manufacture, Upjohn, requested the Food and Drug Administration's (FDA) permission to expand its use as a contraceptive. FDA wanted more clinical data because it was concerned about its effect on future fertility. It also requested animal studies on DMPA's effect on bone deposition and cancer risk. By 1978, there was so much evidence of increase risk of cervical and breast cancer in animal models and of birth defects that FDA decided not to approve DMPA. Upjohn had exhausted all options by 1986. WHO clinical research (conducted in Kenya, Mexico, and Thailand) revealed in 1991 that DMPA was not a carcinogen. In fact, DMPA users had a significantly lower risk of endometrial cancer than women who did not use DMPA. Clinical research in Thailand suggested that DMPA causes an increased risk of low birth weight and neonatal mortality. A case-control study in New Zealand indicated that DMPA users experienced more bond density loss than non-DMPA users. Nevertheless, FDA approved DMPA as a contraceptive in October 1992. It did order Upjohn to do a postmarket study of DMPA's effect on bone density and risk of osteoporosis, however. Despite its approval, the controversies would continue until further research provided more details about cancer and other risks. Before January 1993, Upjohn sold vials of DMPA to clinicians at $11 to $12 per injection. After January 1993, it began selling it in single-dose disposable syringes at a cost of $29.50. When the cost of a clinic visit is added, the cost per DMPA injection increases to about $50 ($200/year).
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PMID:Injectable hormones and regulatory controversy: an end to the long-running story? 843 75

A prospective study was devised in 1980 to assess the effect on survival of neoadjuvant Provera as part of the primary treatment of endometrial carcinoma in conjunction with surgery and radiotherapy. Between June 1980 and June 1985, 218 patients with Stage I adenocarcinoma of the corpus uteri were allocated on the basis of hospital of presentation to receive either neoadjuvant treatment with medroxyprogesterone acetate (MPA) 100 mg t.i.d. p.o. from diagnosis for 90 days, or no adjuvant treatment (the control group). The minimum follow-up was 5 years. There was no significant difference between the overall actuarial survival in the treatment group (123 cases) and that in the control group (95 cases). This was 83.7% and 69.2% at 5 and 10 years respectively in the treatment group and 78.9% and 70.7% in the control group (P > 0.1).
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PMID:Stage I endometrial carcinoma: the role of neoadjuvant progesterone therapy. 848 58

The US Food and Drug Administration finally approved the injectable contraceptive Depo-Provera (DMPA) in October 1992, 25 years after its introduction. Women return to a health facility every 90 days for an intramuscular injection of 150 mg DMPA, which provides them 99% effective contraception. Menstrual changes and spotting are the leading reasons for DMPA discontinuation. Eventually, more than 50% of DMPA users develop amenorrhea. During the first year, women gain about 2 kg and weight increases as time passes. Weight gain is the second leading reason for DMPA discontinuation. DMPA may adversely affect glucose tolerance in women at risk for diabetes, but it does not affect cardiovascular or metabolic functions. It may increase the risk of osteoporosis. A rare side effect is convulsions. 1-10% of DMPA users have other central nervous system effects, such as headaches, dizziness, and depression. Itching and rashes may develop. Fertility returns within 1 year after discontinuation. DMPA is linked to low birth weight. It apparently does not harm breast-fed infants or hinder lactation. A World Health Organization study shows that DMPA users less than 35 years old experience a slight increase in breast cancer but a reduced incidence of endometrial cancer. Nurses are instrumental in guiding women as they choose DMPA and in informing them about its potential side effects, including breast cancer risk. They must screen women for pregnancy and evaluate their risk of breast cancer. They must determine whether women are able to return every 3 months for DMPA injections. Women who select DMPA must use other contraception, e.g., barrier protection, within the first 24 hours after initial injection. Nurses should counsel them about the likely menstrual changes to reduce the likelihood of dissatisfaction. They should recommend a daily dose of 1200 mg of elemental calcium and daily exercise of long bones to minimize the risk of developing osteoporosis.
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PMID:Depo-Provera. 849 47

1. The levels of basic fibroblast growth factor (FGF) expression and secretion and its messenger ribonucleic acid (mRNA) expression in well-differentiated endometrial cancer (Ishikawa) cells were significantly increased by estradiol. 2. This increase was significantly inhibited by tamoxifen, progestins (progesterone, medroxyprogesterone acetate [MPA], and 17 alpha-hydroxyprogesterone), and to some extent danazol, but not by terahydrocortisol and hydrocortisone. 3. Estrogen might stimulate the basic FGF secretion of endometrial cancer cells, at least for neovascularization, and antiestrogenic compounds may inhibit the estrogen-induced event.
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PMID:Antiestrogenic compounds inhibit estrogen-induced expressions of basic fibroblast growth factor and its mRNA in well-differentiated endometrial cancer cells. 959 98

To clarify the effect of sex steroids on neovascularization in the growth, invasion and metastasis of endometrial cancer, the regulations of acid fibroblast growth factor (FGF-1), basic FGF (FGF-2) and hst-1 (FGF-4) mRNA expressions were studied in well-differentiated endometrial cancer cells under the influence of sex steroids. The levels of FGF-1 and 2 mRNAs in the well-differentiated endometrial cancer (Ishikawa) cells were significantly increased by estradiol. This increase was significantly inhibited by progestins (progesterone, medroxyprogesterone acetate [MPA] and 17 alpha-hydroxyprogesterone) and tamoxifen, but not by tetrahydrocortisol, hydrocortisone and danazol. The expression of FGF-4 mRNA was not altered by sex steroids. Therefore, estrogen might stimulate FGF-2 with FGF-1 secretion of endometrial cancer cells for neovascularization, and antiestrogenic compounds do inhibit estrogen-induced events.
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PMID:Antiestrogenic compounds inhibit estrogen-induced expression of fibroblast growth factor family (FGF-1, 2, and 4) mRNA in well-differentiated endometrial cancer cells. 944 20


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