National Cancer Institute®
Last Modified: March 1, 2002
UI - 11544839
AU - Adamian RT
TI - [Therapy of atypical hyperplasia and adenocarcinoma of the endometrium with the combination of progestins and anticoagulants]
SO - Vopr Onkol 2001;47(3):359-62
AD - V.A. Fanarjyan Center for Cancer Research, Ministry of Health of the Republic of Armenia, Yerevan.
The data on clinical trials of newly-developed hormonotherapy of atypical hyperplasia (AH) and cervical adenocarcinoma (CAC) are presented. The study included 34 patients with histologically--confirmed AH and 86--CAC (stage I-II and III-IV). All patients were given preoperative "shock therapy" with a combination of progestins and anticoagulants: 500 mg, i.v., 10 days--(AH) and well-differentiated cell CAC; 20 days--moderately- and poorly-differentiated cell CAC. Total dose was 5 g and 10 g, respectively. Fibrolysin, pelentan and aspirin (antiaggregant of thrombocytes) were used as anticoagulants. For comparison, identical numbers of AH and CAC patients received similar preoperative progestin therapy without anticoagulants. The study was randomized. Hormonal pathomorphosis in tumor was identified after surgery and relevant characteristics of bioptical and resected material were compared. It was found that hormonotherapy used in conjunction with anticoagulants reinforced significantly all features of hormonal pathomorphosism both in AH and CAC stage I-II while, in well-differentiated cell adenocarcinoma, the difference from control was significant (p < 0.05).
UI - 11813151
AU - Chadha M
TI - Gynecologic brachytherapy-II: Intravaginal brachytherapy for carcinoma of the endometrium.
SO - Semin Radiat Oncol 2002 Jan;12(1):53-61
AD - Department of Radiation Oncology, Beth Israel Medical Center, New York, NY 10003, USA.
Brachytherapy plays a significant role in the management of endometrial cancer. In the adjuvant setting, based on pathologic risk factors, intravaginal brachytherapy alone, external radiation therapy alone, or a combination of the two is recommended. For patients who are medically inoperable, brachytherapy with or without external beam therapy is the mainstay of treatment. In recurrent disease, to achieve improved local regional control interstitial and/or intravaginal brachytherapy is used as a boost. This article will highlight the indications and technical aspects of postoperative intravaginal brachytherapy, which is the most common application of brachytherapy in endometrial cancer. Copyright 2002 by W.B. Saunders Company
UI - 11830547
AU - Dai D; Wolf DM; Litman ES; White MJ; Leslie KK
TI - Progesterone inhibits human endometrial cancer cell growth and invasiveness: down-regulation of cellular adhesion molecules through progesterone B receptors.
SO - Cancer Res 2002 Feb 1;62(3):881-6
AD - The Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, 2211 Lomas Boulevard NE, Albuquerque, New Mexico 87131-5286, USA.
Progesterone is a critical steroid hormone that controls cell proliferation and differentiation in the female reproductive tract. Progesterone acts through two nuclear receptor isoforms, progesterone receptors A and B (PRA and PRB, respectively), each with unique cellular effects. Loss of PRB has recently been linked to the development of poorly differentiated endometrial tumors, a lethal form of cancer. To study the molecular effects of progesterone, progesterone receptors were introduced into Hec50co endometrial cancer cells by adenoviral vectors encoding either PRA or PRB. Progesterone induced the cyclin-dependent kinase inhibitors p21 and p27, thereby significantly reducing the percentage of proliferating cells. Cancer cell invasion was also markedly inhibited as measured by Matrigel invasion studies. Similarly, a differentiated, secretory phenotype was induced by progesterone in cells expressing PRB. However, replicative senescence was induced by progesterone only in cells expressing PRA. Expression array analysis followed by confirmatory semiquantitative reverse transcription-PCR experiments demonstrated a significant progesterone-dependent inhibition of expression of a cadre of cellular adhesion molecules, including fibronectin, integrin alpha3, integrin beta1, integrin beta3, and cadherin 6. The level of down-regulation of adhesion molecule expression was significantly greater in the presence of the B isoform, demonstrating that progesterone acts principally through B receptors to inhibit cancer cell invasiveness modulated by adhesion molecules.
UI - 11744954
AU - Ghourab S
TI - Synchronous endometrioid carcinoma of the ovary and endometrium associated with ovulation induction.
SO - Saudi Med J 2001 Oct;22(10):914-6
AD - Department of Obstetrics and Gynecology, King Khalid University Hospital, King Saud University, PO Box 2925, Riyadh 11461, Kingdom of Saudi Arabia. firstname.lastname@example.org
Over the last 2 decades great concern about the possible association between ovarian cancer and ovulation induction has been raised. Between the first reported case in 1982 and the end of year 2000, there have been 44 cases of ovarian carcinoma reported to occur in women previously treated with ovulation induction drugs. Most of these tumors were of the serous type with low malignant potential. In the present case, the patient had secondary anovulatory infertility and previous left cystoophorectomy for ovarian endometrioma. She was treated with human menopausal gonadotrophin alone or in combination with clomiphene citrate for 13 cycles prior to presentation. Screening ultrasound revealed multicystic right ovarian mass (15 x 9 x 6 cm). Hysterectomy and right salpingo-oophorectomy were carried out. Intraoperative and histological examinations showed stage 1A endometrioid ovarian cancer and well-differentiated endometrial adenoacanthoma with minimal myometrial invasion. A brief but critical review of published literature regarding the association of ovulation induction and increased risk of ovarian cancer is presented.
UI - 11840823
AU - Makarov OV; Patrushev LI; Ignatchenko OIu; Ozolinia LA; Dzhobava EM
TI - [Microsatellites instability--actuality and clinical significance in hyperplastic processes and endometrium neoplasm (review of literature)]
SO - Klin Lab Diagn 2001 Dec;(12):16-22
UI - 11857027
AU - Santin AD; Bellone S; Ravaggi A; Roman JJ; Pecorelli S; Parham GP;
TI - Cannon MJ Induction of tumour-specific CD8(+) cytotoxic T lymphocytes by tumour lysate-pulsed autologous dendritic cells in patients with uterine serous papillary cancer.
SO - Br J Cancer 2002 Jan 7;86(1):151-7
AD - Department of Obstetrics and Gynecology, UAMS Medical Center, Division of Gynecologic Oncology, University of Arkansas, 4301 W. Markham, Little Rock, Arkansas AR 72205-7199, USA. email@example.com
Uterine serous papillary carcinoma is a highly aggressive variant of endometrial cancer histologically similar to high grade ovarian cancer. Unlike ovarian cancer, however, it is a chemoresistant disease from onset, with responses to combined cisplatinum-based chemotherapy in the order of 20% and an extremely poor prognosis. In this study, we demonstrate that tumour lysate-pulsed autologous dendritic cells can elicit a specific CD8(+) cytotoxic T lymphocyte response against autologous tumour target cells in three patients with uterine serous papillary cancer. CTL from patients 1 and 2 expressed strong cytolytic activity against autologous tumour cells, did not lyse autologous lymphoblasts or autologous EBV-transformed cell lines, and were variably cytotoxic against the NK-sensitive cell line K-562. Patient 3 CD8(+) T cells expressed a modest but reproducible cytotoxicity against autologous tumour cells only at the time of the first priming. Further priming attempts with PBL collected from patient 3 after tumour progression in the lumboaortic lymph nodes were unsuccessful. Cytotoxicity against autologous tumour cells could be significantly inhibited by anti-HLA class I (W6/32) and anti-LFA-1 MAbs. Highly cytotoxic CD8(+) T cells from patients 1 and 2 showed a heterogeneous CD56 expression while CD56 was not expressed by non-cytotoxic CD8(+) T cells from patient 3. Using two colour flow cytometric analysis of intracellular cytokine expression at the single cell level, a striking dominance of IFN-gamma expressors was detectable in CTL populations of patients 1 and 2 while in patient 3 a dominant population of CD8(+) T cells expressing IL-4 and IL-10 was consistently detected. Taken together, these data demonstrate that tumour lysate-pulsed DC can be an effective tool in inducing uterine serous papillary cancer-specific CD8(+) CTL able to kill autologous tumour cells in vitro. However, high levels of tumour specific tolerance in some patients may impose a significant barrier to therapeutic vaccination. These results may have important implications for the treatment in the adjuvant setting of uterine serous papillary cancer patients with active or adoptive immunotherapy.
UI - 11857302
AU - Emoto M; Tamura R; Shirota K; Hachisuga T; Kawarabayashi T
TI - Clinical usefulness of color Doppler ultrasound in patients with endometrial hyperplasia and carcinoma.
SO - Cancer 2002 Feb 1;94(3):700-6
AD - Department of Obstetrics and Gynecology, Fukuoka University School of Medicine, Fukuoka, Japan. firstname.lastname@example.org
BACKGROUND: The objective of this study was to examine the usefulness of transvaginal color Doppler ultrasound (TV-CDU) in differentiating between endometrial hyperplasia (EH) and endometrial carcinoma (EC) and in predicting tumor spread in patients with EC. METHODS: Seventy-one postmenopausal patients were enrolled with either EH or EC that had been diagnosed by endometrial biopsy. The presence or absence of intratumoral blood flow was assessed by TV-CDU. The intratumoral blood flow characteristics were analyzed using the resistance index (RI), pulsatility index (PI), and peak systolic velocity (PSV). The endometrial thickness also was measured in all patients by gray-scale sonography. The correlation of these sonographic findings with histologic type, tumor grade, surgical stage, myometrial invasion, or the presence or absence of pelvic lymph node metastasis was then evaluated in patients with EC. RESULTS: Although there were no patients with EC with endometrial thickness measuring < 5 mm, no significant difference was found in the mean value of endometrial thickness between patients with EH (n = 18 patients; 16.2 mm +/- 15.9 mm) and patients with EC (n = 53 patients; 18.7 mm +/- 17.1 mm). Intratumoral blood flow was detected in significant numbers of patients who had EC (71.7%; 38 of 53 patients) compared with patients who had EH (5.6%; 1 of 18 patients; P < 0.0001). Thus, no patients with EH showed any blood flow in the endometrial lesions, except for one patient who had EH complicated by pyometra. In patients with EC, the positive rate of intratumoral blood flow was correlated significantly with myometrial invasion, tumor grade, and pelvic lymph node metastasis (P < 0.05; Cochran-Armitage trend test). No associations were found between RI, PI, or PSV and the clinicopathologic parameters examined, including surgical stage. CONCLUSIONS: TV-CDU may be more useful in differentiating between EH and EC than measuring endometrial thickness by transvaginal gray-scale sonography. For patients with EC, the detection of intratumoral blood flow may be helpful in distinguishing between low-grade and high-grade tumors and predicting myometrial invasion. However, intratumoral blood flow analysis using RI, PI, or PSV may not be useful for predicting tumor spread before surgery. Copyright 2002 American Cancer Society. DOI 10.1002/cncr.10208
UI - 11859980
AU - Klee M; Machin D
TI - Health-related quality of life of patients with endometrial cancer who are disease-free following external irradiation.
SO - Acta Oncol 2001;40(7):816-24
AD - Department of Oncology, The Finsen Center, Rigshospitalet, Copenhagen. email@example.com
Health-related quality of life (HQoL) is assessed through the patients' own evaluation of the impact that a disease and its treatment may have on some of the physical, psychological and social aspects of their lives. The purpose of this study is to describe the HQoL of patients with endometrial cancer who are free of disease after undergoing external irradiation. An HQoL questionnaire was designed and validated, and consisted of the EORTC QLQ-C30 and 80 additional questions. The patients provided self-reported assessments at the end of radiotherapy, and 1, 3, 6, 12, 18 and 24 months later. Forty-nine out of 66 potential subjects participated in the study, which was confined to the period during which the, women were disease free. Most patients experience physical side effects at the end of treatment and up to 6 months thereafter; 10% of the patients have chronic local symptoms and a large number of the patients think about their treatment even two years later. The patients' overall evaluation of their quality of life is lower than that of a matched population of healthy women.
UI - 11859985
AU - Mogren I; Stenlund H; Hogberg U
TI - Long-term impact of reproductive factors on the risk of cervical, endometrial, ovarian and breast cancer.
SO - Acta Oncol 2001;40(7):849-54
AD - Department of Clinical Science, Umea University, Sweden. firstname.lastname@example.org
The influence of maternal age, parity, low or high birthweight, multiple births, and pre-eclampsia on the risk of cervical, endometrial, ovarian and breast cancers was studied. Data on 40951 women and the outcomes of their deliveries between 1955 and 1995 were obtained from birth registers. For the mothers, data from the Swedish Cancer Registry and the Cause of Death Register were added. The sample was evaluated using Cox's regression in univariate and bivariate analyses where the relative risk and its 95% confidence interval were calculated. Increasing maternal age at first birth was associated with an increasing relative risk of endometrial, ovarian, and breast cancers, and with a decreased risk of cervical cancer. Multiparity was a protective factor for all gynaecological cancers, including cervical and breast cancers. Multiple births were associated with an increased risk of endometrial cancer.
UI - 11872295
AU - Jereczek-Fossa BA; Jassem J; Badzio A
TI - Relationship between acute and late normal tissue injury after postoperative radiotherapy in endometrial cancer.
SO - Int J Radiat Oncol Biol Phys 2002 Feb 1;52(2):476-82
AD - Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland. email@example.com
PURPOSE: To evaluate the relationship between acute and late normal tissue reactions in 317 consecutive endometrial cancer patients treated with surgery and adjuvant radiotherapy (RT). METHODS: The data of 317 patients (staging according to the International Federation of Gynecology and Obstetrics) treated with postoperative RT were analyzed. Both low-dose-rate brachytherapy and external beam RT were applied in 247 patients (78%); brachytherapy only in 49 (15%) and external beam irradiation only in 21 (7%). The median follow-up was 7.3 years (range 4-21). The European Organization for Research and Treatment of Cancer, Radiation Therapy Oncology Group system with elements of the late effects of normal tissue, subjective, objective, management, analytic (LENT/SOMA) scale was used to score the RT reactions. The correlation between the occurrence and severity of acute and late bowel and bladder toxicity, as well as the relationship between the severity of acute effects and time to occurrence of late reactions, were assessed using linear and logistic regression analyses. RESULTS: Of the 317 patients, 268 (85%) experienced acute RT reactions of any grade. Severe acute bowel reactions were observed in 15 patients (5%), urinary bladder complications in 1 patient (0.5%), cutaneous in 1 patient (0.5%), and vaginal in 1 patient (0.5%). Severe acute hematologic toxicity was seen in 3 patients (1%). A total of 158 patients (51%) experienced late RT reactions of any grade. Severe late bowel reactions were observed in 19 patients (6%), urinary bladder in 5 (2%), vaginal in 3 (1%), and bone in 10 (4%). When all toxic events were considered, there was a highly significant correlation between the acute and late bowel reactions (p <0.001), but the acute and late urinary bladder reactions did not correlate (p = 0.64). The grade of acute toxicity was found to predict the grade of late toxicity for the bowel but not for the bladder (p <0.001 and p = 0.47, respectively). The severity of acute bowel and bladder toxicity did not correlate with the time to occurrence of late toxicity in these locations (p = 0.34 and p = 0.47, respectively). CONCLUSION: Patients with increased acute bowel toxicity during postoperative RT for endometrial cancer have an increased risk of late bowel injury. A higher grade of acute bowel complications correlated with more severe late events, but was not predictive for its latency time. These findings suggest the possibility of an early indication of patients with an increased risk of late toxicity in whom preventive measures might be attempted.
UI - 11846711
AU - Epstein E; Ramirez A; Skoog L; Valentin L
TI - Dilatation and curettage fails to detect most focal lesions in the uterine cavity in women with postmenopausal bleeding.
SO - Acta Obstet Gynecol Scand 2001 Dec;80(12):1131-6
AD - Department of Obstetrics and Gynecology, University of Lund, University Hospital, Malmo, Sweden. firstname.lastname@example.org
OBJECTIVE: To determine the prevalence of focally growing lesions in the uterine cavity in women with postmenopausal bleeding and endometrium > or = 5 mm and the extent to which such lesions can be correctly diagnosed by D&C. METHODS: In a prospective study, 105 women with postmenopausal bleeding and endometrium > or = 5 mm at transvaginal ultrasound examination underwent diagnostic hysteroscopy, D&C and hysteroscopic resection of any focally growing lesion still left in the uterine cavity after D&C. Twenty-four women also underwent hysterectomy. If the histological diagnosis differed between specimens from the same patient, the most relevant diagnosis was considered the final one. RESULTS: Eighty percent (84/105) of the women had pathology in the uterine cavity, and 98% (82/84) of the pathological lesions manifested a focal growth pattern at hysteroscopy. In 87% of the women with focal lesions in the uterine cavity, the whole or parts of the lesion remained in situ after D&C. D&C missed 58% (25/43) of polyps, 50% (5/10) of hyperplasias, 60% (3/5) of complex atypical hyperplasias, and 11% (2/19) of endometrial cancers. The agreement between the D&C diagnosis and the final diagnosis was excellent (94%) in women without focally growing lesions at hysteroscopy. CONCLUSION: If there are focal lesions in the uterine cavity, hysteroscopy with endometrial resection is superior to D&C for obtaining a representative endometrial sample in women with postmenopausal bleeding and endometrium > or = 5 mm.
UI - 11812074
AU - Straughn JM Jr; Huh WK; Kelly FJ; Leath CA 3rd; Kleinberg MJ; Hyde J Jr;
TI - Numnum TM; Zhang Y; Soong SJ; Austin JM Jr; Partridge EE; Kilgore LC; Alvarez RD Conservative management of stage I endometrial carcinoma after surgical staging.
SO - Gynecol Oncol 2002 Feb;84(2):194-200
AD - Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, Alabama 35249, USA. email@example.com
OBJECTIVE: The aim of this study was to determine the outcomes of Stage I endometrial carcinoma patients who are managed without adjuvant radiation after comprehensive surgical staging. METHODS: A computerized hospital database identified women diagnosed with adenocarcinoma of the endometrium from 1993 to 1998. A chart review identified 864 women as having primary surgery for adenocarcinoma of the endometrium. A total of 670 of 864 patients (78%) underwent comprehensive surgical staging with total hysterectomy, bilateral salpingo-oophorectomy, pelvic/para-aortic lymphadenectomy, and peritoneal cytology. After 57 patients with high-risk histologic subtypes were excluded, 613 patients remained for analysis. RESULTS: A total of 321 of 325 Stage IB patients (99%) did not receive adjuvant radiation. Fifteen of 321 patients (5%) recurred; 9 recurred in the pelvis or vagina. All 9 local recurrences were salvaged with whole pelvic radiation (XRT) and brachytherapy (BT). Seventy-seven patients were diagnosed with Stage IC disease; 53 (69%) received no adjuvant therapy. Four patients (8%) recurred, of which 2 recurred in the vagina. Three of 4 patients (75%) were salvaged, 2 with XRT/BT and 1 with surgery and chemotherapy. For all Stage I patients, the 5-year disease-free survival was 93% and the 5-year overall survival was 98%. CONCLUSIONS: Surgically staged patients with endometrial carcinoma confined to the uterine corpus have a small risk of recurrence and the majority of these recurrences can be salvaged with radiation therapy. Conservative management of Stage I endometrial carcinoma patients is an effective treatment strategy. B)2001 Elsevier Science.
UI - 11812081
AU - Plaxe SC; Blessing JA; Husseinzadeh N; Webster KD; Rader JS; Dunton CJ
TI - Phase II trial of pyrazoloacridine in patients with persistent or recurrent endometrial carcinoma: a Gynecologic Oncology Group Study.
SO - Gynecol Oncol 2002 Feb;84(2):241-4
AD - Division of Gynecologic Oncology, University of California at San Diego, San Diego, California 92103, USA.
OBJECTIVES: The aims of this study were to determine the response rate of pyrazoloacridine (PZA) in patients with recurrent or persistent endometrial carcinoma and to describe the nature and degree of toxicity in this population. METHODS: PZA was initially administered at a dose of 750 mg/m(2) intravenously over 3 h every 3 weeks but, due to toxicity, was subsequently reduced to 560 mg/m(2) at the same schedule. RESULTS: Among 23 evaluable patients, 11 of whom had had prior chemotherapy, there was 1 (4.3%) partial response and no complete responses. Forty-eight percent of patients had grade 4 neutropenia. There was 1 treatment-related death, in a patient who had prior chemotherapy and radiotherapy. CONCLUSION: This dose and schedule of PZA has insignificant activity in this population. The optimal PZA dose appears to vary between different populations and may be related to prior therapy. B)2001 Elsevier Science.
UI - 11812084
AU - Alcazar JL; Galan MJ; Jurado M; Lopez-Garcia G
TI - Intratumoral blood flow analysis in endometrial carcinoma: correlation with tumor characteristics and risk for recurrence.
SO - Gynecol Oncol 2002 Feb;84(2):258-62
AD - Department of Obstetrics and Gynecology, University of Navarra, Pamplona, Spain. firstname.lastname@example.org
OBJECTIVE: The aim of this study was to correlate intratumoral blood flow as assessed by transvaginal color Doppler ultrasound with tumor histopathologic characteristics, tumoral stage, and risk for recurrence in endometrial carcinoma. METHODS: Forty-five patients (mean age: 58.2 years, range: 30 to 83 years) with surgically treated endometrial carcinoma preoperatively evaluated with transvaginal color Doppler ultrasound were included in this retrospective study. The lowest arterial resistance index (RI) and highest peak systolic velocity (PSV) were used for intratumoral blood flow analysis. Individual tumor characteristics evaluated were tumor growth pattern, tumor size, histologic type, tumor grade, myometrial infiltration depth, cervical involvement, lymph node metastasis, and lymph-vascular space invasion (LVSI). Tumoral stage and risk for recurrence were also evaluated. RESULTS: Significantly lower RI was found in tumors with the following characteristics: infiltrative growth pattern (P = 0,013), grade 3 (P = 0.001), infiltrating >or=50% of the myometrium (P = 0.006), cervical involvement (P = 0.009), LVSI (P = 0.008), lymph-node metastasis (P = 0.049), stage >or=Ic (P = 0.004), and high risk for recurrence (P = 0.001). Significantly higher PSV was found in tumors that were grade 3 (P = 0.034), infiltrating >or=50% of the myometrium (P = 0.029), stage >or=Ic (P = 0.015), and with a high risk for recurrence (P = 0.002). CONCLUSIONS: Our data indicate that a correlation between intratumoral blood flow features and histopathological characteristics, tumor stage, and risk for recurrence exists in endometrial cancer. Further prospective studies are needed to determine the clinical usefulness of preoperative assessment of tumor vascularization in these carcinomas. (c)2002 Elservier Science
UI - 11812096
AU - Mekhail TM; Markman M
TI - Acanthosis nigricans with endometrial carcinoma: case report and review of the literature.
SO - Gynecol Oncol 2002 Feb;84(2):332-4
AD - Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. Mekhait@CCF.ORG
BACKGROUND: Acanthosis nigricans is classified into benign and malignant forms on the basis of clinical associations. The main interest in acanthosis nigricans has been based on its association with malignancy because of the dramatic clinical appearance of the skin lesions and the usually rapidly fatal nature of the underlying disease. "Tripe palms" is a descriptive term of acanthosis nigricans of the palms. It more often is associated with internal malignancy. Most importantly, it often precedes the diagnosis of a new or recurrent tumor. Malignant acanthosis nigricans is most commonly associated with intra-abdominal malignancies. There are very few reports in the literature of malignant acanthosis nigricans associated with gynecological malignancies. Only five cases of endometrial carcinoma associated with acanthosis nigricans and/or tripe palms have been reported in the literature. CASE: A 69-year-old African-American female presented with skin changes consistent with the diagnosis of acanthosis nigricans and tripe palms. More than 14 months later she was found to have endometrial carcinoma. She subsequently underwent total abdominal hysterectomy and salpingo-oophorectomy followed by chemotherapy with paclitaxel and carboplatin. During treatment of the underlying malignancy the skin condition dramatically improved. CONCLUSION: Tripe palms can be associated with endometrial carcinoma and may be the first sign of malignancy. Malignant acanthosis nigricans may improve with treatment of the underlying malignancy. Patients who present with tripe palms may need to undergo workup to search for underlying malignancy. B)2001 Elsevier Science.
UI - 11848551
AU - Bellino R; Arisio R; D'Addato F; Alba E; Attini R; Colla F; Leotta E;
TI - Tersiev P; Grio R Pathologic features of endometrial carcinoma in elderly women.
SO - Anticancer Res 2001 Sep-Oct;21(5):3721-4
AD - Department of Gynecology and Obstetrics, Sant'Anna Hospital, University of Turin, Italy.
It has been estimated that more than two-thirds of cancers occur in people over 65 years of age: endometrial cancer (EC) is the most common gynaecologic cancer in the U.S. and represents the fourth most common malignancy in women. Some authors have reported that EC in elderly women was more aggressive, histologically less-differentiated and often non-endometrioid when compared with EC in the younger population. The purpose of this retrospective study is to evaluate the pathologic features of EC in women 70 years old or over compared with those of younger patients. Between 1987 and 1997, 174 patients with EC were surgically treated: 52 women were 70 years old or over. Two-thirds of both groups had surgical Stage I tumors: 54% of surgical Stage I tumors in the elderly had myometrial invasion more than 50% compared with 32% in the younger group (p<0.01). On the whole 37% of elderly patients had Stage IC tumors compared with 21% in younger women (p<0.01). Seventy-five percent of elderly women had Grade 2 or 3 tumors compared with 55% of younger patients (p<0.005). The majority of EC was endometrioid in both groups: 8% of elderly patients had clear-cell carcinomas compared with 4% of younger women (p not significant). No elderly patients showed nodal metastasis (0 out of 10): 9% of younger women had pelvic or para-aortic metastasis. The median follow-up was 78 months. The overall survival in the elderly and in the younger group was 80% and 93%, respectively (p<0.01): in elderly women overall survival significantly varied according to histotype and depth of myometrial invasion in Stage I tumors. In conclusion patients 70 years old or over have a high probability of surgical Stage I EC but a significantly higher probability of deep myometrial invasion and less-differentiated tumors than younger women: the prognosis w as good but poorer than for younger patients.
UI - 11813332
AU - Karim BO; Burroughs FH; Rosenthal DL; Ali SZ
TI - Endometrial-type cells in cervico-vaginal smears: clinical significance and cytopathologic correlates.
SO - Diagn Cytopathol 2002 Feb;26(2):123-7
AD - John K. Frost Cytopathology Laboratory, Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD 21287-6417, USA.
This study assessed the significance of endometrial-type cells (ETC) in cervico-vaginal (CV) smears in patients 45 yr and older by evaluating quantitatively and qualitatively the relationship of ETC to subsequent endometrial pathology. In a 3-yr period (1997-1999) at the Johns Hopkins Cytopathology Laboratory, 1,162 CV smears with ETC were found in patients 45 yr and older. In all cases with positive follow-up by tissue biopsy/resection, i.e., endometrial hyperplasia (EHP) and endometrial adenocarcinoma (EACA), the CV smears were reevaluated and compared to the control group (i.e., patients with normal endometrial biopsies). The following cytologic characteristics were recorded: quantity of ETC, type of ETC (epithelial, stromal/histiocyte-type, or mixed), cellular atypism, presence of inflammation, smear background, and associated estrogen effect. Of the 1,162 patients with ETC, 432 cases (37%) had tissue follow-up as follows: EACA, 18 (4.2%); EHP, 20 (4.6%); leiomyomata, 17 (3.9%); endometrial polyp, 21 (4.9%); benign/within normal limits (WNL), 339 (78.5%); nondiagnostic, 17 (3.9%). Cytologic characteristics of ETC showed subtle but definite quantitative and qualitative differences in the major pathologic groups examined. All instances of cancers and hyperplasia occurred in postmenopausal (PM) women. Abnormal vaginal bleeding was the presenting complaint in 66.7% of EACA, 45% of EHP, and 28.6% of benign endometrium. ETC in PM CV smears are associated with significant endometrial lesions (carcinoma, hyperplasia) in less than 9% of the patients. It is concluded that the distinction between EACA and EHP can be difficult. The presence of a large number of ETC, predominantly of epithelial or a mixed (epithelial and stromal) type, is more often associated with EACA or EHP than with benign endometrium. The presence of cytologic atypia and/or diathesis is additionally helpful for the diagnosis of EACA.
UI - 11854630
AU - Volker P; Grundker C; Schmidt O; Schulz KD; Emons G
TI - Expression of receptors for luteinizing hormone-releasing hormone in human ovarian and endometrial cancers: frequency, autoregulation, and correlation with direct antiproliferative activity of luteinizing hormone-releasing hormone analogues.
SO - Am J Obstet Gynecol 2002 Feb;186(2):171-9
AD - Department of Obstetrics and Gynecology, Georg-August-University Gottingen, Germany.
OBJECTIVE: Several recent reports have demonstrated the expression of luteinizing hormone-releasing hormone receptors by human ovarian and endometrial cancers. Controversy persists on the relevance of this finding, in particular whether these receptors mediate direct antiproliferative effects of luteinizing hormone-releasing hormone analogues. We correlated the expression of luteinizing hormone-releasing hormone receptors by well-characterized ovarian and endometrial cancer cell lines with the ability of luteinizing hormone-releasing hormone analogues to reduce their proliferation and studied the autoregulation of luteinizing hormone-releasing hormone receptor expression by luteinizing hormone-releasing hormone agonist triptorelin and antagonist cetrorelix. The expression of luteinizing hormone-releasing hormone receptors was assessed in a series of specimens from primary ovarian and endometrial cancers. STUDY DESIGN: Luteinizing hormone-releasing hormone receptor expression was assessed by semiquantitative reverse transcriptase-polymerase chain reaction and radioligand binding assay. Antiproliferative effects were ascertained by proliferation assays in the absence or presence of luteinizing hormone-releasing hormone analogues. RESULTS: Ovarian (4/6 cell lines) and endometrial (5/6 cell lines) cancer cell lines expressed luteinizing hormone-releasing hormone receptors. The proliferation of these luteinizing hormone-releasing hormone receptor-positive cell lines was dose- and time-dependently reduced by agonistic and antagonistic luteinizing hormone-releasing hormone analogues. Luteinizing hormone-releasing hormone receptor density was reduced to 80% of controls (control, 100 %; P <.001) by luteinizing hormone-releasing hormone analogues. Seventy percent of primary ovarian cancers and 83% of primary endometrial cancers expressed luteinizing hormone-releasing hormone receptors. CONCLUSION: These findings suggest that luteinizing hormone-releasing hormone receptors that are expressed by human ovarian and endometrial cancer cell lines mediate direct antiproliferative effects of luteinizing hormone-releasing hormone analogues. Because most respective primary cancers expressed luteinizing hormone-releasing hormone receptors, these receptors might be used for novel antiproliferative therapeutic approaches and should be further evaluated.
UI - 11728663
AU - Holub Z; Jabor A; Kliment L; Voracek J; Lukac J; Barany B
TI - Laparoscopic staging of endometrial cancer using laparosonic instruments: comparison with electrosurgery.
SO - Eur J Obstet Gynecol Reprod Biol 2001 Dec 10;100(1):81-6
AD - Endoscopic Training Center, Department of Gynecology and Obstetrics, Baby Friendly Hospital, Vancurova 1548, 27258 Kladno, Czech Republic. email@example.com
OBJECTIVE: To compare perioperative parameters in two groups of women with different laparoscopic operative techniques in surgical staging of endometrial cancer (EC). STUDY DESIGN: Thirty randomly allocated and laparoscopically treated women with EC. Fifteen patients were operated by electrosurgery, 15 patients by laparosonic operative technique. Differences between the two groups were determined by the Wilcoxon rank-sum test. Probability (P) of less than 0.05 was considered significant. SETTING: Department of Gynecology and Obstetrics, Endoscopic Training Center, Baby Friendly Hospital, Kladno, Czech Republic. RESULTS: Laparoscopy was successfully completed in 29 patients. Laparoscopy-assisted surgical staging of EC was performed based on the tumor grade and the depth of myoinvasion. In both groups, in total 18 and 5 women underwent pelvic lymphadenectomy (PLN) and infra-aortic lymph node sampling (IALS), respectively. Three patients had metastases in pelvic lymph nodes. In the electrosurgical hemostasis and laparosonic group the mean total time required to finish the whole operative procedure were 132.1 and 138.3 min, respectively, with no statistically significant difference (P=0.96). There were no significant differences between the groups in any intraoperative or postoperative follow-up variables, except for the number of excised lymph nodes where the difference between electrosurgery and laparosonic group (12.7 versus 18) was statistically significant (P=0.05). In one patient with intraoperative venous bleeding the laparosonic hemostasis was ineffective (successful procedure rate 93.3%). One patient from the electrosurgery group was converted to laparotomy due to injury to the epigastric vessels. This complication had no connection with the surgical techniques studied. CONCLUSION: It is concluded that both operative technique variants in laparoscopy-assisted surgical staging appear to be feasible and effective for patients with EC.
UI - 10502434
AU - Chadha M; Nanavati PJ; Liu P; Fanning J; Jacobs A
TI - Patterns of failure in endometrial carcinoma stage IB grade 3 and IC patients treated with postoperative vaginal vault brachytherapy.
SO - Gynecol Oncol 1999 Oct;75(1):103-7
AD - Department of Radiation Oncology, Beth Israel Medical Center, New York, New York, 10003, USA.
OBJECTIVE: The vagina is the most common site of locoregional failure in surgical stage IB, IC, and II (occult) endometrial adenocarcinoma. The objective of this study is to evaluate the therapeutic efficacy of vaginal vault brachytherapy alone for surgical stage I patients with high-risk features. MATERIALS AND METHODS: The study group consists of high-risk stage I patients with either stage IB grade (G) 3 or any grade endometrial carcinoma were treated postoperatively with high-dose-rate vaginal vault brachytherapy as the only adjuvant treatment. All patients were surgically staged. Among them, 38 patients were identified as high risk. Twelve patients had stage IBG3, 14 had ICG1, 9 had ICG2, and 3 had ICG3 disease. The median age was 67 years (range 41 to 86 years). A dose of 21 Gy in three fractions of 7 Gy each was delivered to a prescription depth of 0.5 cm from the surface of the vaginal applicator using high-dose-rate brachytherapy. RESULTS: The median follow-up was 30 months (range 7 to 91 months). No patient has developed a vaginal or pelvic recurrence. Three patients developed tumor recurrence in the upper abdomen at 11, 18, and 37 months. Two of the three patients with recurrent disease also had history of breast cancer. In one patient, breast cancer was diagnosed 4.8 years prior and in the second 3 years subsequent to the diagnosis of endometrial cancer. The 5-year actuarial overall survival and disease-free survival are 93 and 87%, respectively. There was no treatment-related grade 3 or 4 morbidity observed. CONCLUSIONS: For patients with surgical stage IBG3 and IC, excellent local control and minimal morbidity has been observed with the selective use of vaginal brachytherapy alone. Further studies and longer follow-up are warranted. Copyright 1999 Academic Press.
UI - 10502417
AU - Naumann RW; Higgins RV; Hall JB
TI - The use of adjuvant radiation therapy by members of the Society of Gynecologic Oncologists.
SO - Gynecol Oncol 1999 Oct;75(1):4-9
AD - Carolinas Medical Center, Charlotte, North Carolina, 28232, USA.
OBJECTIVES. The aim of this study was to determine the attitudes of the members of the Society of Gynecologic Oncologists with respect to the use of adjuvant radiation therapy in women with endometrial cancer. METHODS: An anonymous survey concerning the use of adjuvant radiation therapy in endometrial cancer was mailed to all members of the Society of Gynecologic Oncologists listed in the 1998 directory. RESULTS: Of the 767 listed members, 325 (42%) returned completed surveys. Less than 20% of respondents recommended adjuvant radiation therapy in stage IA grade 1 or 2 and stage IB grade 1 endometrial cancer. Adjuvant radiation is recommended by 40 to 50% of respondents in women with stage IA grade 3 and IB grade 2 tumors. Most recommend adjuvant radiation for all women with >50% myometrial invasion or grade 3 tumors with any myometrial invasion. Lymph node sampling is attempted in all cases by 48% of respondents. For those familiar with Gynecologic Oncology Group (GOG) Study No. 99, 20% stated that they were more likely to recommend adjuvant radiation and 27% stated that they were less likely to recommend adjuvant radiation based on the preliminary results. Except in stage IA grade 1 tumors, the chance of recommending further therapy in women with all stages and grades was significantly less if a complete staging procedure including lymph node dissection had been performed. CONCLUSIONS: Complete staging appears to decrease the chance that postoperative therapy will be recommended. The use of adjuvant radiation therapy seem to have declined slightly as a result of GOG Study No. 99. Future studies in women with endometrial cancer that do not require lymph node sampling should evaluate the frequency of adjuvant therapy in the absence of complete staging. Copyright 1999 Academic Press.
UI - 11036892
AU - Bergman L; Beelen ML; Gallee MP; Hollema H; Benraadt J; van Leeuwen FE
TI - Risk and prognosis of endometrial cancer after tamoxifen for breast cancer. Comprehensive Cancer Centres' ALERT Group. Assessment of Liver and Endometrial cancer Risk following Tamoxifen.
SO - Lancet 2000 Sep 9;356(9233):881-7
AD - Department of Epidemiology, Netherlands Cancer Institute, Amsterdam.
BACKGROUND: Tamoxifen increases the risk of endometrial cancer. However, few studies have produced reliable risk estimates by duration, dose, and recency of use, or addressed the prognosis of endometrial cancers in tamoxifen-treated women. METHODS: We did a nationwide case-control study on the risk and prognosis of endometrial cancer after tamoxifen use for breast cancer. Information on tamoxifen use and other risk factors for endometrial cancer was obtained from 309 women with endometrial cancer after breast cancer (cases), and 860 matched controls with breast cancer but without endometrial cancer. For 276 cases, we obtained tissue blocks of endometrial cancer to review the diagnosis, and used immunohistochemistry to examine hormone-receptor status and overexpression of p53. FINDINGS: Tamoxifen had been used by 108 (36.1%) of 299 cases and 245 (28.5%) controls (relative risk 1.5 [95% CI 1.1-2.0]). Risk of endometrial cancer increased with longer duration of tamoxifen use (p < 0.001), with relative risks of 2.0 (1.2-3.2) for 2-5 years and 6.9 (2.4-19.4) for at least 5 years compared with non-users. Endometrial cancers of stage III and IV occurred more frequently in long-term tamoxifen users (> or = 2 years) than in non-users (17.4% vs 5.4%, p=0.006). Long-term users were more likely than non-users to have had malignant mixed mesodermal tumours or sarcomas of the endometrium (15.4% vs 2.9%, p < or = 0.02), p53-positive tumours (31.4% vs 18.2%, p=0.05), and negative oestrogen-receptor concentrations (60.8% vs 26.2%, p < or = 0.001). 3-year endometrial-cancer-specific survival was significantly worse for long-term tamoxifen users than for non-users (76% for > or = 5 years, 85% for 2-5 years vs 94% for non-users, p=0.02). INTERPRETATION: Long-term tamoxifen users have a worse prognosis of endometrial cancers, which seems to be due to less favourable histology and higher stage. However, the benefit of tamoxifen on breast-cancer survival far outweighs the increased mortality from endometrial cancer. Nevertheless, we seriously question widespread use of tamoxifen as a preventive agent against breast cancer in healthy women.
UI - 11104626
AU - Ng TY; Perrin LC; Nicklin JL; Cheuk R; Crandon AJ
TI - Local recurrence in high-risk node-negative stage I endometrial carcinoma treated with postoperative vaginal vault brachytherapy.
SO - Gynecol Oncol 2000 Dec;79(3):490-4
AD - Queensland Centre for Gynaecological Cancer, Queensland Radium Institute, Queensland, 4001, Australia.
OBJECTIVES: The aim of this study is to examine the patterns of failure after extended surgical staging and postoperative vaginal vault brachytherapy as the only adjuvant treatment in high-risk surgical Stage I patients with endometrial carcinoma. METHODS: The records of all patients with endometrial carcinoma (adenocarcinoma or adenosquamous) receiving vaginal vault brachytherapy as the only adjuvant treatment patients were found. Of these, 133 had extended surgical staging. The study group consists of 77 surgical Stage I patients with Substages IBG3 and any grade IC. Recurrences were recorded as in the vagina, pelvis, or distant. RESULTS: The mean follow-up interval was 45 months (range 14 to 96 months). Eleven patients had recurrence (14%). Median time to recurrence was 15 months (range 6 to 56 months). Recurrences occurred in the vagina in 7, pelvis in 1, and distantly in 3 patients. Five of 7 vaginal recurrences occurred within 2 years. All patients with distant recurrence died from disease. One patient with pelvic recurrence is alive with disease. Only 1 patient with vaginal recurrence died from disease. Six patients with isolated recurrences in the vagina were successfully treated with radiotherapy with or without local excision. All 6 have no evidence of disease at follow-up (median survival 29 months, range 20 to 71 months). CONCLUSIONS: The vagina remains the most common site of recurrence for high-risk surgical Stage I patients treated with postoperative vaginal vault brachytherapy. Close follow-up in the first 2 years is essential to detect isolated vaginal recurrences. These are amenable to salvage treatment with good disease-free survival. Copyright 2000 Academic Press.
UI - 11197376
AU - Narod SA; Pal T; Graham T; Mitchell M; Fyles A
TI - Tamoxifen and risk of endometrial cancer.
SO - Lancet 2001 Jan 6;357(9249):65-6; discussion 67