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Abramson Cancer CenterNCI CANCERLIT® Search: Endometrial Cancer - October 2001
National Cancer Institute®
Last Modified: November 21, 2001
Table of Contents
1
UI - 21284034
AU - Gibbons WE; Thorneycroft IH
TI -
Protecting the endometrium. Opposing the hyperplasia/malignancy
potential of ERT.
SO - J Reprod Med 1999 Feb;44(2 Suppl):203-8
AD - Department of Obstetrics and Gynecology, Eastern Virginia Medical
School, 601 Colley Avenue, Suite 229, Norfolk, VA 23507-1627, USA.
Many trials have examined the clinical and histologic effects of various
hormone replacement therapy combinations with the objective of
minimizing the incidence of hyperplasia and the potential for subsequent
development of adenocarcinoma. Reviewing the results of these trials, it
appears that high-dose, long-term progestogen therapy is effective in
protecting the endometrium, with duration having a greater impact than
dose. Among women given 0.625 mg conjugated equine estrogen (CEE),
sequential regimens should include 5 or 10 mg medroxyprogesterone
acetate (MPA) or 200 mg micronized progesterone for 12 days or more.
Continuous combined regimens require 2.5-5 mg MPA. With women who are
taking 1.25 mg CEE the data are less clear, but recommendations include
administration with 10 mg MPA for 12-14 days or 5 mg MPA continuous
combined therapy.
2
UI - 21332387
AU - Valenzano M; Podesta M; Giannesi A; Corticelli A; Nicoletti L;
TI -
Costantini S
[The role of transvaginal ultrasound and sonohysterography in the
diagnosis and staging of endometrial adenocarcinoma]
SO - Radiol Med (Torino) 2001 May;101(5):365-70
AD - Dipartimento di Ginecologia e Ostetricia, Universita degli Studi,
Ospedale S. Martino, Padiglione 1, Genova, Italy.
PURPOSE: The aim of this study is to evaluate the accuracy of
sonohysterography in early diagnosis of endometrial tumor lesions and in
the detection of myometrial infiltration for staging. MATERIAL AND
METHODS: We performed sonohysterography as a preoperative test in 24
patients with an hystologic diagnosis of endometrial adenocarcinoma
obtained by hysteroscopy and biopsy. The mean age of the patient was
between 50 and 82 years. The sonohysterographic examination was
performed by using 5.0 and 6.0 MHz transvaginal probes and a 5 or 7
French hysteroinjectors with inflating balloon. 19 of the 24 patients
were enrolled in the study: in 2 cases the examination was not
technically performable, 2 patients refused surgical treatment and 1
patient had a cervical adenocarcinoma with extension to the myometrium.
In each patient we evaluated the number and the size of the lesions and
the degree and the depth of myometrial infiltration. Each parameter was
compared with the final histopathologic examination. RESULTS:
Sonohysterography showed a single lesion in 15 patients, whereas in 4
patients it showed multiple lesions; in 1 of these patients it showed 3
lesions which were, in reality, a single lesion that infiltrated the
first half of the myometrium. Myometrial infiltration was correctly
evaluated by the examination in 17 of the 19 women (89.4%): 16 positive
and 1 negative case. The sensitivity was 88%, the specificity 100%, the
positive predictive value 100% and the negative predictive value 33%.
The sonohysterography allowed to evaluate exactly the depth of
myometrial invasion in 15 of the 16 cases (93.7%), in which a myometrial
infiltration was suspected. With regard to this parameter the
sensitivity was 85.7%, the specificity was 100%, the positive predictive
value 100% and the negative predictive value 90.9%. CONCLUSIONS:
Although the introduction of transvaginal ultrasonography in clinical
practice allows to obtain an early diagnosis of endometrial
adenocarcinoma, about half patients seems to present already at the
diagnosis myometrial invasion. Moreover 50% of these patients seems to
have pelvic lymphonodes and about 29% positive paraaortic lymphonodes.
Currently myometrial invasion is evaluated by the extemporary frozen
test and confirmed by the definitive hystologic examination. It would be
helpful to have a technique able to detect and evaluate infiltration
before surgery. The results of this study suggest that sonohysterography
could have a role in preoperative staging. However these data need to be
confirmed by further studies.
3
UI - 21338538
AU - Seki N; Kodama J; Hashimoto I; Hongo A; Yoshinouchi M; Kudo T
TI -
Thrombospondin-1 and -2 messenger RNA expression in normal and
neoplastic endometrial tissues: correlation with angiogenesis and
prognosis.
SO - Int J Oncol 2001 Aug;19(2):305-10
AD - Department of Obstetrics and Gynecology, Okayama University Medical
School, 2-5-1 Shikata-cho, Okayama 700-8558, Japan.
The role of thrombospondin (TSP) in tumor angiogenesis and progression
remains controversial. The expression of TSP-1 and TSP-2 mRNAs was
assessed. Furthermore, TSP association with clinicopathological
features, including microvessel count, regarding prognostic significance
was examined. Expression of TSP-1 and TSP-2 were assessed by reverse
transcriptase-polymerase chain reaction in 18 normal endometrium and 55
endometrial cancer samples. Microvessel counts were determined by
immunostaining for factor VIII-related antigen in endometrial cancer
specimens. TSP-1 expression of secretory phase endometrium was markedly
higher than that of proliferative phase endometrium (p=0.047).
Expression of TSP-1 and TSP-2 was detected in 33 (60.0%) and 15 cases
(27.3%), respectively, of 55 endometrial cancer samples. TSP-1
expression was significantly higher in tumors recovered from elderly
women (p=0.009). TSP-2 expression was significantly higher in
malignancies exhibiting cervical and lymph-vascular space involvement
(p=0.029 and p=0.009, respectively). Although not statistically
significant, microvessel counts were higher in cases displaying
increased TSP-1 expression. The microvessel count in patients with TSP-2
expression was markedly higher than that observed in patients lacking
TSP-2 expression (p=0.026). Subjects demonstrating TSP-2 mRNA expression
displayed significantly poorer prognosis than those lacking TSP-2 mRNA
expression (p=0.016). There was no association between TSP-1 mRNA
expression and patient outcome. Our findings provide evidence that
elevated TSP expression may be associated with an angiogenic phenotype
in endometrial cancer. In addition, TSP-2 expression is a marker for
poor prognosis in this disease.
4
UI - 21377749
AU - Burkart C; Wight E; Pok J; Kernen B; Traber M; Haller U; Bajka M
TI -
[Ultrasound endometrium follow-up during tamoxifen treatment: Really not
reliable or useful after all?]
SO - Ultraschall Med 2001 Jun;22(3):136-42
AD - Klinik fur Gynakologie, Dept. Frauenheilkunde, Universitatsspital
Zurich, Schweiz.
AIM: To investigate whether an examination of the endometrium of women
treated with tamoxifen (TAM) is useful or not. METHOD: 40 breast cancer
patients who displayed a thickened endometrium of > 8 mm and/or vaginal
bleeding were included in the study. They received daily TAM adjuvantly.
Histologic clarification by hysteroscopy and D&C was recommended for
patients with an endometrium of > 8 mm or vaginal bleeding. RESULTS: In
our collective, the mean endometrial thickness was 13.7 +/- 5.6 mm (SD).
32 patients underwent a histological examination. Most had a benign
lesion; in 2 cases we merely found a cystic atrophy (11 mm, 18 mm), 2
displayed atypical tissue (13 mm, 25 mm) and 2 an endometrial cancer (19
mm, 33 mm). All patients with atypical tissue or cancer had an
endometrial thickness markedly above the norm, but 3 of them were not
bleeding. No linear correlation between thickness of the endometrium and
duration of TAM intake was found. CONCLUSION: To detect early
premalignant or malignant changes of the endometrium, we recommend
histological examination by hysteroscopy and dilatation and curettage
when the endometrium is > 8 mm thick, even in the absence of symptoms.
Therefore, these patients should have regular examinations by
transvaginal ultrasound once or twice a year. Moreover, continuing
regular screening of the endometrium for years after termination of
tamoxifen-therapy is also to be recommended.
5
UI - 21372586
AU - Sironi S; Villa G; Rossi S; Bocciolone L; Maggioni A; Sonzogni A;
TI -
Bellomi M
[Magnetic resonance imaging in the evaluation of parametrial invasion of
carcinoma of the cervix uteri: optimization of the study protocol]
SO - Radiol Med (Torino) 2001 Jun;101(6):477-84
AD - Divisione di Radiologia Diagnostica, Istituto Europeo di Oncologia,
Milan, Italy.
PURPOSE: To determine the efficacy of three different MR sequences in
the evaluation of parametrial invasion by early-stage cervical cancer.
MATERIAL AND METHODS: Eighteen consecutive patients with cervical cancer
clinically assessed as stage IB1 underwent MR imaging examination with
the use of the following sequences: FSE T2-weighted, FSE fat-suppressed
T2w, and SE fat-suppressed Gadolinium-enhanced T1w. In all cases, the
presence or absence of parametrial invasion on both sides per each
sequence used was evaluated. Subsequently all the sequences have been
considered together for the evaluation of tumor invasion. Gold standard
of the study was the histopathologic analysis of the surgical specimens.
RESULTS: At histological examination, parametrial invasion by tumor was
found in 6 out of 36 parametria evaluated. The accuracy achieved with
each of the sequences used was as follows: 94% with FSE T2w; 86% with
FSE fat-suppressed T2w; and 67% with SE fat-suppressed
Gadolinium-enhanced T1w. The simultaneous evaluation of all 3 sequences
obtained an accuracy level similar to that achieved with FSE T2w. The
difference between the accuracy of T2w sequences and that of
fat-suppressed contrast-enhanced T1w sequences was statistically
significant (p<0.01). DISCUSSION AND CONCLUSIONS: Our data suggest that
the MR imaging protocol for the evaluation of parametrial tumor invasion
could be restricted to FSE T2w sequences. These proved to have the
highest negative predictive value (97%) which allows a reliable
selection of patients who can be surgically treated.
6
UI - 21411912
AU - Nishimura N; Hachisuga T; Saito T; Kawarabayashi T
TI -
Subsequent endometrial carcinoma with adjuvant tamoxifen treatment in
Japanese breast cancer patients.
SO - Int J Gynecol Cancer 2001 Jul-Aug;11(4):272-6
AD - Department of Obstetrics and Gynecology, School of Medicine, Fukuoka
University, Japan.
This study aimed to detail the clinicopathologic features of endometrial
carcinomas that developed in Japanese patients receiving adjuvant
tamoxifen treatment for breast cancer patients. Ten endometrial
carcinomas in tamoxifen-treated breast cancer patients were collected
from two medical centers. The endometrial carcinomas included two stage
Ia, four stage Ib, two stage Ic and two stage IIIc. Three tumors were
Grade 1, six were Grade 2, and one was Grade 3. The tumor was limited to
the endometrium in two cases. Myometrial invasion was limited to the
inner half of the myometrium in five cases and involved the outer half
in three. A mild degree of lymphovascular space invasion was identified
in five cases. Deep cervical invasion was recognized in one case. The
cell types comprised nine endometrioid adenocarcinomas and one serous
carcinoma. Five of eight postmenopausal endometrial carcinomas were
associated with polypoid endometrial lesions composed of cystically
dilated atrophic and proliferative glands widely separated by fibrotic
stroma. Two patients with retroperitoneal lymph node metastases died of
endometrial cancer. One patient developed a contralateral breast cancer
during tamoxifen treatment. No patient died of breast cancer. We did not
demonstrate a higher frequency of either high-grade tumors or
unfavorable histologic subtypes in tamoxifen-treated Japanese breast
cancer patients.
7
UI - 21411918
AU - Nguyen NP; Sallah S; Karlsson U; Vos P; Ludin A; Semer D; Tait D;
TI -
Salehpour M; Jendrasiak G; Robiou C
Prognosis for papillary serous carcinoma of the endometrium after
surgical staging.
SO - Int J Gynecol Cancer 2001 Jul-Aug;11(4):305-11
AD - Department of Radiation Oncology, Southwestern University, Dallas, Texas
75216, USA. NamPhong.Nguyen@med.va.gov
BACKGROUND: To investigate the pattern of failure and the prognosis
following pathological staging for uterine papillary serous carcinoma
(UPSC). PATIENTS AND METHODS: A retrospective review was conducted of 22
patients with UPSC, treated between 1989 and 1998 at a single
institution. All patients were surgically staged. Two patients with
advanced disease received chemotherapy only. Two patients with
early-stage disease were followed without further treatment. Eighteen
patients received postoperative irradiation; eight patients received
whole abdominal irradiation (WART), and the remaining 10 patients,
pelvic irradiation (PRT). In addition, seven of these patients received
vaginal cuff irradiation with low-dose-rate or high-dose-rate
brachytherapy. Toxicity, pattern of failure, and survival were evaluated
and compared to the literature. RESULTS: Seven patients (32%) developed
distant metastases, three out of seven (42%) after WART. Four out of
seven patients who had distant metastases died from disease progression
during subsequent chemotherapy. All patients with distant metastases had
locally advanced-stage disease at presentation (six stage III, one stage
IV). Four patients with pelvic recurrences developed concurrent (2) and
subsequent (2) distant metastases. Three patients had isolated distant
metastases. No patient with early stage-disease (stage I and II) died
from disease progression. CONCLUSION: Pathological staging should be
performed for all patients with UPSC to determine the prognosis as well
as to tailor the treatment. The role of abdominal irradiation in the
treatment of UPSC is yet to be determined; however, such an approach may
not be necessary for the control of disease for patients with
early-stage (I and II) disease. Patients with locally advanced-stage
(stage III) disease are at risk of local regional failures and distant
metastases despite WART. Therefore, the benefit of WART for
advanced-stage disease is also questionable. Paclitaxel-based
chemotherapy is currently being investigated in this setting.
8
UI - 21426235
AU - Vazquez EG; Abad JA
TI -
[Pleuro-pericardial metastasis in adenocarcinoma of endometrium]
SO - An Med Interna 2001 Jul;18(7):392
9
UI - 21439110
AU - Minaguchi T; Yoshikawa H; Oda K; Ishino T; Yasugi T; Onda T; Nakagawa S;
TI -
Matsumoto K; Kawana K; Taketani Y
PTEN mutation located only outside exons 5, 6, and 7 is an independent
predictor of favorable survival in endometrial carcinomas.
SO - Clin Cancer Res 2001 Sep;7(9):2636-42
AD - Department of Obstetrics and Gynecology, Faculty of Medicine, University
of Tokyo, Tokyo 113-8655, Japan. minaguchit-gyn@h.u-tokyo.ac.jp
Although the prognostic impact of PTEN mutation in endometrial carcinoma
is beginning to be analyzed, the prognostic significance of mutated PTEN
exons has not ever been described. Sixty-seven endometrial carcinomas
were analyzed for PTEN mutations using single-strand conformation
polymorphism analysis and DNA sequencing. First, survival rates were
compared according to PTEN status and mutated PTEN exons. Subsequently,
univariate and multivariate analyses of various favorable prognostic
factors for survival were conducted. The associations between PTEN
mutation and clinicopathological features were also statistically
evaluated. PTEN mutations were detected in 37 of 67 (55%) specimens.
Among 47 mutations, frameshifts (57%) and mutations in exon 8 (38%) were
most frequent. In univariate analysis, a factor of PTEN mutation only
outside exons 5-7 was associated with significantly better survival (P =
0.02), although mutation in any exon of PTEN was not (P = 0.33).
Subsequent multivariate analysis revealed that factors of mutation only
outside exons 5-7 of PTEN, stage I/II, and G1 were significant and
independent prognostic indicators for favorable survival (P = 0.004,
0.004, and 0.0006, respectively). In the subset of advanced-stage
disease, mutation only outside exons 5-7 was associated with a trend
toward better survival (P = 0.13). No significant correlation was
observed between PTEN mutation and estrogen-related clinicopathological
features. In conclusion, we find that PTEN mutation located only outside
exons 5-7 is a significant and independent positive prognostic indicator
for survival. The current observation has prognostic and therapeutic
implications for the management of patients with endometrial carcinoma.
10
UI - 21455241
AU - Cohen I; Azaria R; Bernheim J; Shapira J; Beyth Y
TI -
Risk factors of endometrial polyps resected from postmenopausal patients
with breast carcinoma treated with tamoxifen.
SO - Cancer 2001 Sep 1;92(5):1151-5
AD - Department of Obstetrics and Gynecology, Sapir Medical Center,
Kfar-Saba, Tel Aviv University, Israel. ruth@clalit.org.il
BACKGROUND: Endometrial polyps are the most common endometrial pathology
described in association with postmenopausal tamoxifen exposure. Up to
3% of these polyps may show malignant changes. However, to the authors'
knowledge no one has described any risk factor for the development of
this pathology in postmenopausal patients with breast carcinoma treated
with tamoxifen. OBJECTIVE. The objective of this study was to evaluate
whether risk factors can be identified for the development of
endometrial polyps in postmenopausal patients with breast carcinoma
treated with tamoxifen. METHODS: The authors reviewed the medical
records of 54 postmenopausal patients with breast carcinoma in whom
endometrial polyps were resected by hysteroscopy after at least 6 months
of tamoxifen treatment (Group I). Demographic characteristics, health
habits, risk factors for endometrial carcinoma, and clinical factors
related to the primary breast disease were examined. The results were
compared with those obtained from 210 similar patients in whom
hysteroscopy did not reveal any endometrial pathology (Group II).
RESULTS: Age at menopause was significantly older, duration of breast
disease was significantly longer, and body weight was significantly
heavier among Group I patients compared with Group II patients (P =
0.0162, P = 0.0026, and P = 0.0364, respectively). Endometrial
thickness, measured by transvaginal ultrasonography, was significantly
thicker in Group I patients (16.3 +/- 7.2 mm) compared with that
detected in Group II patients (11.8 +/- 6.3; P = 0.0001). CONCLUSIONS:
Various factors, such as older age at menopause, longer duration of
breast disease, heavier weight, and thicker endometrium may contribute
to the prediction of increased risk of development of endometrial polyps
in postmenopausal patients with breast carcinoma treated with tamoxifen.
Copyright 2001 American Cancer Society.
11
UI - 21455245
AU - Yaron M; Levy T; Chetrit A; Levavi H; Sabah G; Schneider D; Halperin R;
TI -
Ben-Rafael Z; Friedman E
The polymorphic CAG repeat in the androgen receptor gene in Jewish
Israeli women with endometrial carcinoma.
SO - Cancer 2001 Sep 1;92(5):1190-4
AD - Department of Obstetrics and Gynecology, Assaf Harofe Medical Center,
Zemifin, Israel.
BACKGROUND: Endometrial carcinoma is considered a hormonal-dependent
tumor; estrogen induces endometrial cellular proliferation, whereas
progestins display an antiproliferative effect on endometrial tissue.
The role that androgen and its receptor (androgen receptor [AR]) play in
the pathogenesis of endometrial carcinoma is less clear. Although
androgen has an in vitro inhibitory effect on endometrial cell
proliferation, up to 75% of endometrial carcinoma express AR
somatically. A polymorphic CAG repeat within exon 1 of the AR encodes
for a polyglutamine tract, with length range of 8 to 33 repeats, which
is inversely correlated with the transcriptional activity of the AR.
METHODS: To gain insight into the role of AR in endometrial carcinoma,
the authors analyzed the polymorphic CAG repeat in 79 Jewish Israeli
patients with endometrial carcinoma as compared with 44 healthy Jewish
women serving as controls. Analysis was conducted using germline DNA as
template and using polymerase chain reaction primers flanking the CAG
repeat with subsequent fluorescent determination of allele sizes.
RESULTS: Allele size range of the longer of the two alleles in the
patients was 11-33 (mean, 19.8 +/- 2.7) and in the controls 10-22 (mean,
17.9 +/- 1.9), a statistically significant difference (P < 0.01). Allele
size variation within the patient group did not correlate with disease
stage, grade, reproductive history, or age at diagnosis. CONCLUSIONS:
The authors conclude that AR-CAG repeat length differs in Jewish
patients with endometrial carcinoma as compared with healthy individuals
in Israel, and this finding increases the possibility that the AR is
involved in the predisposition to this neoplasm. Copyright 2001 American
Cancer Society.
12
UI - 20538588
AU - Gomez-Fernandez CR; Ganjei-Azar P; Behshid K; Averette HE; Nadji M
TI -
Normal endometrial cells in Papanicolaou smears: prevalence in women
with and without endometrial disease.
SO - Obstet Gynecol 2000 Dec;96(6):874-8
AD - Department of Pathology, University of Miami/Jackson Memorial Medical
Center, Miami, Florida 33136, USA.
OBJECTIVE: To determine whether the prevalence of normal endometrial
cells in Papanicolaou smears of women with and those without endometrial
carcinoma or hyperplasia differs significantly. METHODS: Papanicolaou
smears of women with biopsy-proved endometrial hyperplasia or carcinoma
diagnosed between 1990 and 1998 were reviewed for the presence of normal
endometrial cells. Chi-square and a power analysis were used to compare
these smears with results of smears from women older than 35 years of
age with tissue diagnoses other than hyperplasia or carcinoma. All
Papanicolaou smears obtained within the 5 years before endometrial
sampling were reviewed. Each patient had at least one smear done within
the previous 12 months. Clinical information was available for all
patients. RESULTS: Of the 201 women in whom endometrial hyperplasia (n =
103) or carcinoma (n = 98) was diagnosed, 4 (2%) had normal endometrial
cells in otherwise negative Papanicolaou smears. Of the 289 women in the
comparison group, 15 (5%) had normal endometrial cells in their
Papanicolaou smears. The prevalence of normal endometrial cells did not
differ significantly between the two groups (P =.071). The study had 80%
power to detect a 5% or greater difference between groups. CONCLUSION:
The prevalence of normal endometrial cells in Papanicolaou smears of
women with endometrial carcinoma or hyperplasia does not significantly
differ from that in women without these conditions. Reporting normal
endometrial cells in Papanicolaou smears according to the
recommendations of the Bethesda System may lead to unnecessary
procedures and patient anxiety.
13
UI - 21251403
AU - Zucker PK; Kasdon EJ
TI -
Normal endometrial cells in Papanicolaou smears: prevalence in women
with and without endometrial disease.
SO - Obstet Gynecol 2001 May;97(5 Pt 1):798-9
14
UI - 21468594
AU - Saul H
TI -
Doubts raised over tamoxifen as preventive agent.
SO - Eur J Cancer 2000 Dec;36(18):2281
15
UI - 21435103
AU - Sliwinska M; Wojtacki J; Sliwinski W
TI -
Endometrial cancer in patients with breast carcinoma treated with
tamoxifen: report of two cases and the literature overview.
SO - Med Sci Monit 2000 Mar-Apr;6(2):399-406
AD - Department of Radiotherapy, Polish Red Cross Marine Hospital,
Gdynia-Redlowo, Poland.
Tamoxifen (TAM) is the endocrine treatment of choice in the first-line
therapy for all stages of breast cancer, in both pre- and postmenopausal
women. Some clinical studies indicated a small but significant increase
in the risk of subsequent endometrial carcinoma in breast cancer women
who take TAM as an adjuvant therapy. In this study, we present two cases
of breast cancer patients in whom endometrial cancer was diagnosed
during TAM treatment; the current status of knowledge on the
relationship between TAM use and the risk of endometrial cancer is
reviewed.
16
UI - 21268053
AU - Terlikowski S; Lenczewski A; Famulski W; Sulkowska M; Kulikowski M
TI -
Proliferative activity in endometrial hyperplasia and adenocarcinoma.
SO - Folia Histochem Cytobiol 2001;39(2):163-4
AD - Department of Gynecology and Septic Obstetrics, Medical Academy,
Bialystok, Poland.
Studies on the proliferative activity of cells in endometrial
hyperplasia and adenocarcinoma were performed using techniques detecting
Proliferating Cell Nuclear Antigen (PCNA) and Nucleolar Organizer
Regions (NORs). PCNA expression was defined as the percentage of nuclei
showing reactivity in 200 cells per sample. The mean AgNOR count per
cell was calculated following the analysis of at least 100 nuclei per
sample at a magnification of x 400. Student-t test was used for the
statistical analysis. The results obtained indicate that the evaluation
of cell proliferative activity expressed by AgNOR count and PCNA index
can help in the distinction between atypical hyperplasia and
well-differentiated adenocarcinoma, and thus can serve as a useful
pathological criterion.
17
UI - 21290401
AU - Del Priore G; Williams R; Harbatkin CB; Wan LS; Mittal K; Yang GC
TI -
Endometrial brush biopsy for the diagnosis of endometrial cancer.
SO - J Reprod Med 2001 May;46(5):439-43
AD - Divisions of Gynecologic Oncology and Gynecologic Pathology, Department
of Obstetrics and Gynecology, Kaplan Cancer Center, New York University
School of Medicine, New York, New York, USA. gyn.oncology@med.nyu.edu
OBJECTIVE: To evaluate a new technique for processing endometrial
cytology for the diagnosis and exclusion of endometrial cancer. STUDY
DESIGN: All women at risk for endometrial cancer with clinical
indications for endometrial biopsy were evaluated by endometrial brush
biopsy (Tao Brush, Cook OB-GYN, Bloomington, Indiana) and Pipelle
(Cooper Surgical, Shelton, Connecticut) endometrial biopsies during one
office visit. Patients were followed longitudinally for the development
of endometrial cancer or until undergoing dilatation and curettage or
hysterectomy. All comparisons were analyzed using the chi 2 or t test.
RESULTS: One hundred one women (mean age, 58; range, 35-86) had
endometrial biopsies performed. Median follow-up was > 21 months (range,
3-29). Twenty-two had cancer or atypia, while the remaining had benign
diagnoses. When correlated with the final diagnosis, the Tao Brush had
95.5% sensitivity and the Pipelle, 86% sensitivity. Both devices had
100% specificity, positive predictive value of 100% and negative
predictive value of 98%. When the results of the two biopsy devices are
considered together, the positive and negative predictive value for
detecting or excluding endometrial cancer was 100%. Based on 1998
Medicare reimbursements, a simultaneous second office biopsy using the
Tao brush could save approximately $67 per case as compared to a
sonohistogram and much more when compared to dilatation and curettage.
CONCLUSION: Endometrial cancer can be reliably detected and excluded
using these two distinct office biopsy devices simultaneously during one
office visit. In patients with an indication for endometrial biopsy, no
further diagnostic test may be necessary to exclude or diagnose
endometrial cancer or atypia.
18
UI - 21290410
AU - Yang X; Heller DS; Sama J
TI -
Incidental finding of malignant mixed mesodermal tumor at hysterectomy
for uterine prolapse. A case report.
SO - J Reprod Med 2001 May;46(5):490-2
AD - Department of Pathology and Laboratory Medicine, UH/E141, University of
Medicine and Dentistry of New Jersey-New Jersey Medical School, 185
South Orange Avenue, Newark, NJ 07103, USA.
BACKGROUND: The finding of unanticipated pathology in a uterus after
vaginal hysterectomy for prolapse is uncommon. CASE: An incidental small
malignant mixed mesodermal tumor was found at vaginal hysterectomy in a
68-year-old woman. CONCLUSION: A MED-LINE search found no other reported
cases of malignant mixed mesodermal tumor in a patient undergoing
vaginal hysterectomy for uterine prolapse. Unexpected endometrial and
cervical lesions will be discovered occasionally after hysterectomy for
benign disease.
19
UI - 21427134
AU - Friedrich MJ
TI -
Recent studies bring risks, benefits of hormone replacement therapy
under scrutiny.
SO - J Natl Cancer Inst 2001 Sep 5;93(17):1287-8
20
UI - 21298907
AU - Gallego H; Crutchfield CE 3rd; Wilke MS; Lewis EJ
TI -
Delayed EPPER syndrome.
SO - Arch Dermatol 2001 Jun;137(6):821-2
21
UI - 21461957
AU - Smith RA; von Eschenbach AC; Wender R; Levin B; Byers T; Rothenberger D;
TI -
Brooks D; Creasman W; Cohen C; Runowicz C; Saslow D; Cokkinides V; Eyre
H; ACS Prostate Cancer Advisory Committee, ACS Colorectal Cancer
Advisory Committee, ACS Endometrial Cancer Advisory Committee
American Cancer Society guidelines for the early detection of cancer:
update of early detection guidelines for prostate, colorectal, and
endometrial cancers. Also: update 2001--testing for early lung cancer
detection.
SO - CA Cancer J Clin 2001 Jan-Feb;51(1):38-75; quiz 77-80
AD - Department of Cancer Control, American Cancer Society, Atlanta, GA, USA.
Updates to the American Cancer Society (ACS) guidelines regarding
screening for the early detection of prostate, colorectal, and
endometrial cancers, based on the recommendations of recent ACS
workshops, are presented. Additionally, the authors review the
"cancer-related check-up," clinical encounters that provide case-finding
and health counseling opportunities. Finally, the ACS is issuing an
updated narrative related to testing for early lung cancer detection for
clinicians and individuals at high risk of lung cancer in light of
emerging data on new imaging technologies. Although it is likely that
current screening protocols will be supplanted in the future by newer,
more effective technologies, the establishment of an organized and
systematic approach to early cancer detection would lead to greater
utilization of existing technology and greater progress in cancer
control.
22
UI - 21277674
AU - Velji K; Fitch M
TI -
The experience of women receiving brachytherapy for gynecologic cancer.
SO - Oncol Nurs Forum 2001 May;28(4):743-51
AD - Princess Margaret Hospital, Toronto, Ontario, Canada.
karima.velji@rmp.uhn.on.ca
PURPOSE/OBJECTIVES: To explore and document the lived experience of
receiving low-dose rate brachytherapy for gynecologic cancer. DESIGN:
Qualitative method based on phenomenology. SETTING: Radiation treatment
facility in a cancer-care setting in Toronto, Ontario, Canada. SAMPLE:
Ten women between the ages of 36 and 75 (x = 59.2) receiving low-dose
rate brachytherapy for cancer of the cervix or endometrium. METHODS:
Verbatim data were analyzed manually using Giorgi's method of analyzing
qualitative data. FINDINGS: Three themes emerged from the data: (a)
women's experiences with brachytherapy were embedded within the complete
context in which treatment was given, shaped by personal, environmental,
and treatment-related factors, (b) the discomfort that women experienced
during brachytherapy was perceived as a totality of symptoms including
but not limited to pain, and (c) the brachytherapy experience was
characterized by an intense focus on time and tensions embedded in
issues related to time. CONCLUSIONS: When dealing with the brachytherapy
treatment, women are concerned with the context in which the treatment
is provided and the care that is associated with the treatment.
Different and unique strategies assist women to get through treatment.
Supportive nursing interventions can be implemented easily in the
nursing care plan for women undergoing brachytherapy. IMPLICATIONS FOR
NURSING PRACTICE: The aspects of nursing care that women perceive as
positive, such as competence level of the nurse, symptom management, and
providing information in sensory terms, should be strengthened.
Alternatively, aspects of nursing care that are perceived negatively by
women should be changed. Nurses have to avoid situations that will
prolong the time of brachytherapy treatment. Nurses should support women
in using coping strategies that assist them in getting through the
brachytherapy treatment.
23
UI - 21303837
AU - Lin Z; Cho S; Jeong H; Kim H; Kim I
TI -
Immunohistochemical analysis of CD44s and CD44v6 in endometriosis and
adenomyosis : comparison with normal, hyperplastic, and malignant
endometrium.
SO - J Korean Med Sci 2001 Jun;16(3):317-22
AD - Department of Pathology, Korea University Medical College, Seoul Korea.
The expression patterns of CD44s and CD44v6 were immunohistochemically
compared with those of normal, hyperplastic and malignant endometrium.
In normal endometria (n=37), endometrioses (n=46) and adenomyoses
(n=20), the surface and glandular epithelial cells were negative for
CD44s and CD44v6 in a proliferative pattern and positive in a secretory
pattern, whereas the stroma was only positive for CD44s in both
proliferative and secretory patterns. The endometrial hyperplasia (4
simple and 9 complex) had the identical patterns with normal
proliferative phase of endometrium. Only one case showing complex
hyperplasia with atypia was focally positive for CD44s and CD44v6 in
glandular epithelia. CD44s and CD44v6 were positive in all endometrial
adenocarcinomas (13), except one CD44s-negative case. In summary, the
expressions of CD44s and CD44v6 in endometriosis and adenomyosis
recapitulated those of normal cyclic endometrium. The expression
patterns in endometrial hyperplasia were similar to those in normal
proliferative endometrium, whereas the endometrial adenocarcinoma showed
abnormal expressions for CD44s and CD44v6. Thus it was considered that
the ectopic endometrium in endometriosis and adenomyosis was not
aberrant as in endometrial carcinoma on the aspects of
immunohistochemical expressions of CD44s and CD44v6.
24
UI - 21408642
AU - Aldred MA
TI -
Shedding light on endometrial cancer.
SO - Trends Mol Med 2001 Aug;7(8):335
25
UI - 21459466
AU - Yanoh K; Takeshima N; Hirai Y; Minami A; Tsuzuku M; Toyoda N; Hasumi K
TI -
Identification of a high-risk subgroup in cytology-positive stage IIIA
endometrial cancer.
SO - Acta Cytol 2001 Sep-Oct;45(5):691-6
AD - Department of Gynecology and Diagnostic Cytology, Cancer Institute
Hospital, Tokyo, Japan.
OBJECTIVE: To identify a high-risk subgroup among patients with
cytology-positive stage IIIA endometrial cancer. STUDY DESIGN:
Fifty-four stage IIIA endometrial cancer patients who were positive only
on peritoneal cytology were divided into two groups based on the
cytologic pattern of their peritoneal smears. In group A, malignant cell
clusters had well-defined edges, while the tumor cell clusters had
scalloped edges in group B. The prognostic significance of these
findings was investigated. RESULTS: The five-year disease-free survival
rate was 97.5% in group A (n=40) versus 50% in group B (n = 14).
Multivariate analysis confirmed that the cytologic pattern had an
independent influence on survival. CONCLUSION: Positive peritoneal
cytology composed of malignant cell clusters with well-defined edges has
no impact on survival. Only endometrial cancer patients who show tumor
cell clusters with scalloped edges in peritoneal smears are worth
considering for upstaging.
26
UI - 21236779
AU - Jain MG; Rohan TE; Howe GR; Miller AB
TI -
A cohort study of nutritional factors and endometrial cancer.
SO - Eur J Epidemiol 2000;16(10):899-905
AD - Department of Public Health Sciences, University of Toronto, Toronto,
Ontario, Canada. meera.jain@utoronto.ca
To evaluate the role of nutritional factors in the etiology of
endometrial cancer, we performed a case-cohort analysis using data from
women enrolled in the National Breast Screening Study in Canada from
1980 to 1985. For this analysis, a subcohort was constructed by
selecting a 10% random sample from the 56,837 women in the dietary
cohort. Cases were the 221 women diagnosed with incident adenocarcinoma
of the endometrium during follow-up to December 31, 1993 and ascertained
by record linkage to the Canadian Cancer Database. Information on usual
diet at enrollment and other epidemiological variables was collected by
means of self-administered questionnaires. Hazard ratios were obtained
from proportional hazards regression models, with estimation of robust
standard errors. We found a strong association of endometrial cancer
with body mass index > 25 kg/m2 (hazard ratio 2.72, 95% CI: 2.06-3.50).
Endometrial cancer risk was not associated significantly with intakes of
total energy, carbohydrates, proteins, total fat and major fatty acids,
total dietary fiber and various types of fibers, vitamin C, E and A,
folic acid, beta-carotene, lutein, or cryptoxanthin. Some decrease in
risk was noted with relatively high intakes of saturated fat, animal fat
or lycopene. The associations observed in the study were independent of
total energy intake and most non-dietary risk factors. The study
suggests that dietary intakes of energy and most major nutrients are not
related to the risk of endometrial cancer among Canadian women.
27
UI - 21387616
AU - Durst B; Sorg RV; Roder G; Betz B; Beckmann MW; Niederacher D; Bender
TI -
HG; Dall P
The influence of hormones on CD44 expression in endometrial and breast
carcinomas.
SO - Oncol Rep 2001 Sep-Oct;8(5):987-93
AD - Department of Obstetrics and Gynecology, Heinrich-Heine-University,
D-40225 Dusseldorf, Germany.
The expression of distinct variant isoforms of the cell surface
glycoprotein CD44 (CD44v) has been found to be associated with
metastatic potential of rodent adenocarcinoma cells and with an altered
prognosis in several types of human cancer. In hormone-dependent
gynecological cancers, different CD44v expression patterns have been
observed. The influence of ovarian steroid hormones and their
antagonists on CD44v expression is still unclear, since there are only
retrospective correlation studies so far. Therefore, we examined the
CD44 mRNA expression in a standardized stimulation experiment in a
number of breast and endometrial carcinoma cell lines varying in
estrogen receptor (ER) status. Higher CD44 overall expression was
observed in ER positive endometrial and breast carcinoma cell lines when
compared to corresponding ER negative cell lines. The number and
composition of alternatively spliced isoforms showed no clear
correlation to the ER expression status. Three CD44v isoforms were
detected in all cell lines expressing CD44v, two of which have not been
reported previously in normal endometrial cells. These isoforms may have
specific functions in this type of carcinoma. In the second part of the
study, the influence of (anti-) hormones on CD44 expression in
endometrial carcinoma cell lines was examined. CD44 overall expression
showed an increase when the cells were grown in medium containing fetal
calf serum (FCS) as compared to cells maintained in medium-free of FCS.
CD44 expression was transiently increased by estradiol (1 h). The CD44
splice pattern of endometrial cancer cell lines RL95-2 and Hec-1-A,
after treatment with (anti-) hormones showed constant and high
expression rates for distinct CD44v-isoforms such as CD44E (CD44v8-v10).
Only certain weakly expressed isoforms changed their expression level
during the experimental period, but no direct correlation to hormone
treatment was observed. In conclusion, estradiol or FCS increase CD44
overall expression, but there seems to be no direct influence of ovarian
steroid hormones on the CD44v splice machinery in endometrial carcinoma
cell lines.
28
UI - 21423767
AU - McCluggage WG; Sumathi VP; Maxwell P
TI -
CD10 is a sensitive and diagnostically useful immunohistochemical marker
of normal endometrial stroma and of endometrial stromal neoplasms.
SO - Histopathology 2001 Sep;39(3):273-8
AD - Department of Pathology, Royal Group of Hospitals Trust, Belfast,
Northern Ireland. glenn.mccluggage@bll.n-i.nhs.uk
AIMS: The CD10 antigen is expressed in acute lymphoblastic leukaemia and
follicle centre cell lymphoma. A recent study investigating the
expression of CD10 in a wide range of non-haematopoietic neoplasms found
positive staining in a small number of endometrial stromal sarcomas as
well as in normal endometrial stroma. The present study aimed to
ascertain whether CD10 positivity is indeed found in normal endometrial
stroma and endometrial stromal neoplasms. Staining of a range of tumours
which can be confused morphologically with endometrial stromal neoplasms
was also undertaken to ascertain whether antibodies against CD10 are of
value in a diagnostic sense. METHODS AND RESULTS: Neoplasms included in
the study were endometrial stromal nodule (n=1), low-grade endometrial
stromal sarcoma (ESS) (n=13), high-grade ESS (n=6), mixed endometrial
stromal-smooth muscle tumour (n=1), uterine cellular leiomyoma (n=10),
uterine leiomyosarcoma (n=5), adult granulosa cell tumour (AGCT) (n=10),
undifferentiated endometrial carcinoma (n=6), uterine carcinosarcoma
with an endometrial stromal component (n=1) and type II uterine
mesenchymal tumour with sex cord-like elements (n=1). Cases of
proliferative (n=5), secretory (n=5) and atrophic (n=3) endometrium were
also stained. There was positive staining of stroma but not of glands in
all cases of non-tumorous endometrium. There was positive staining of
the endometrial stromal nodule and of all low-grade ESS. Staining in
these varied but was often diffuse and of moderate to strong intensity.
There was positive staining of four of six high-grade ESS, but this was
usually focal. There was also positive staining of the endometrial
stromal component in the mixed endometrial stromal-smooth muscle tumour
and in the uterine carcinosarcoma. Most cellular leiomyomas were
completely negative although three exhibited weak positivity. There was
some positivity, usually focal or weak, of three of five
leiomyosarcomas. Most AGCT and undifferentiated carcinomas were
completely negative although one case of each exhibited focal staining.
There was focal staining of the type II uterine mesenchymal tumour with
sex cord-like elements. CONCLUSION: CD10 is a reliable and sensitive
immunohistochemical marker of normal endometrial stroma. Positivity,
which is often strong and/or diffuse is found in endometrial stromal
nodules and low-grade ESS. Positive staining with CD10, when strong and
diffuse, may be useful in distinguishing these tumours from histological
mimics, especially cellular leiomyoma and AGCT which are generally
negative. In this situation, CD10 should be used as part of a panel
which might include desmin and alpha-inhibin depending on the
differential diagnosis considered. Positive staining with CD10 in a
high-grade uterine sarcoma which is negative with muscle markers might
indicate endometrial stromal differentiation and identify a group of
neoplasms which it is correct to diagnose as high-grade ESS rather than
undifferentiated uterine sarcoma.
29
UI - 21439162
AU - Mahavni V; Sood AK
TI -
Hormone replacement therapy and cancer risk.
SO - Curr Opin Oncol 2001 Sep;13(5):384-9
AD - Division of Gynecologic Oncology, Department of Obstetrics and
Gynecology, Holden Comprehensive Cancer Center, University of Iowa
Hospitals and Clinics, Iowa City, Iowa, USA.
The advantages and disadvantages of hormone replacement therapy (HRT)
have been debated nearly as long as the treatment has been in use,
especially the relationship between HRT and risk of cancer development.
It is hoped that recently published studies will shed more light on this
complex issue. Several large population studies suggest that there may
be a small but increased risk of developing breast cancer in HRT users,
especially in estrogen and progesterone users. This risk appears most
pronounced after 5 years of HRT use. Endometrial cancer, which has long
been associated with unopposed estrogen use, can be successfully
prevented with the addition of progestins to the HRT regimen, provided
it is given for at least 10 days each month. Estrogen replacement
therapy has also been shown to significantly reduce the risk for colon
cancer but not rectal cancers. Finally, a large prospective study has
linked HRT with an increase in ovarian cancer mortality.
30
UI - 21439167
AU - Orr JW Jr; Roland PY; Leichter D; Orr PF
TI -
Endometrial cancer: is surgical staging necessary?
SO - Curr Opin Oncol 2001 Sep;13(5):408-12
AD - Florida Gynecologic Oncology, Lee Cancer Care, Fort Myers, Florida
33901, USA. james.orr@leememorial.org
Surgical staging has become the standard of care for the treatment of
women with endometrial cancer. Recent scientific publications have
confirmed the relative safety of this procedure when performed by
subspecialty trained surgeons and have provided compelling evidence that
the routine use of postoperative teletherapy is not cost effective, nor
does it offer improved survival. New questions as to the safety and
effectiveness of a laparoscopic staging approach have been answered in
the affirmative. Although the extent of staging has not yet been
defined, growing evidence suggests that preoperative studies and
intraoperative clinical opinion cannot be consistently counted on to be
predictive of postoperative histologic status. Therefore, all patients
should be considered at risk and should undergo an operation in a
clinical situation that offers the immediate availability of
retroperitoneal staging or cytoreductive surgery if necessary.
31
UI - 21469881
AU - Aoki Y; Kase H; Watanabe M; Sato T; Kurata H; Tanaka K
TI -
Stage III endometrial cancer: analysis of prognostic factors and failure
patterns after adjuvant chemotherapy.
SO - Gynecol Oncol 2001 Oct;83(1):1-5
AD - Department of Obstetrics and Gynecology, Niigata University Graduate
School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata
951-8510, Japan. yoichi@med.niigaya-u.ac.jp
OBJECTIVE: This study was performed to assess the prognostic factors and
patterns of recurrence in stage III endometri
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