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Abramson Cancer CenterNCI CANCERLIT® Search: Endometrial Cancer - February 2002
National Cancer Institute®
Last Modified: February 1, 2002
Table of Contents
1
UI - 11731188
AU - Maia H; Maltez A; Athayde C; Coutinho EM
TI -
Proliferation profile of endometrial polyps in post-menopausal women.
SO - Maturitas 2001 Dec 14;40(3):273-81
AD - Endoscopy Unit, CEPARH, Rua Caetano Moura, 35, Salvador 40210-341,
Bahia, Brazil. humrepbahia@e-net.com.br
OBJECTIVE: To determine whether or not the presence of c-erbB2
over-expression in endometrial polyps affects the percentage of cells
positive for Ki-67 proliferation marker. METHODS: Thirty-five patients
with endometrial polyps were submitted to polypectomy by hysteroscopy.
Ki-67 and c-erbB2 over-expression were investigated in the polyps by
immunohistochemistry. RESULTS: The presence of c-erbB2 over-expression
by immunohistochemistry was observed in 80% of endometrial polyps and
was associated with higher proliferation rates as determined by the
number of positive Ki-67 cell nuclei. In c-erbB2-negative polyps, the
proliferation rates were low. CONCLUSION: Ki-67 and c-erbB2
over-expression are frequent in endometrial polyps in post-menopausal
women.
2
UI - 11791283
AU - Brandner P; Neis KJ
TI -
Diagnosis of endometrial cancer and its precursors.
SO - Contrib Gynecol Obstet 2000;20():27-40
AD - St. Theresia Caritas Hospital, Gynecological Clinic, School of
Midwifery, Saarbrucken, Germany. percy.brandner@t-online.de
Whereas cervical carcinoma is reliably detectable by the noninvasive
methods of cytological/cervical smear and HPV typing even in the early
stages, endometrial carcinoma thus far eludes effective check-up.
Neither ultrasound nor invasive procedures such as Pipelle de Cornier,
abrasio fracta or hysteroscopy, succeeded in making the majority of
endometrial carcinomas detectable at an early stage in systematic
screenings. Several factors contribute to this fact: first, only a
fraction of these carcinomas develops through early stages of atypical
hyperplasia, whereas the majority develops de novo. As the most suitable
screening method in general, ultrasound fails in pre- and perimenopausal
women, who account for 30% of new endometrial carcinoma cases. Moreover,
patient compliance with preventive examinations is especially low in the
high risk population of senior women. And, finally, there are issues
regarding the clinical consequences of improved diagnosis, since
endometrial carcinomas may become clinically significant in only 1 of
every 4-6 patients, whereas the majority of these malignomas remains
clinically inapparent. Hence, atypical uterine bleeding will continue to
be the main symptom prompting hysteroscopic and histological
clarification (H&H) and ensuing detection of endometrial carcinomas and
their early stages.
3
UI - 11791287
AU - Tercanli S; Kochli OR; Hoesli I; Feichter G; Schaub A; Holzgreve W
TI -
Differentiation and management of endometrium abnormalities and
leiomyomas by hydrosonography.
SO - Contrib Gynecol Obstet 2000;20():69-80
AD - Department of Ultrasound, University Hospital Basel, Switzerland.
tercanlis@uhbs.ch
Transvaginal sonography is an established method for numerous clinical
indications in the assessment of endometrium pathology. The
investigation of the endometrium consists of the measurement of the
thickness, the visualization of the echogenity and echotexture and of
the demonstration of focal masses. However, evaluation of the uterine
cavity by transvaginal sonography is limited and an abnormal ultrasound
of the endometrium may reflect benign or malignant conditions.
Furthermore, small structures can be missed or overlooked. If indicated,
hydrosonography offers various advantages compared to dilatation and
curettage and hysteroscopy in terms of costs, availability and risks.
Additional informations obtained after hydrosonography may influence the
management before consideration of curettage or hysteroscopy.
4
UI - 11584479
AU - Wu HH; Schuetz MJ 3rd; Cramer H
TI -
Significance of benign endometrial cells in Pap smears from
postmenopausal women.
SO - J Reprod Med 2001 Sep;46(9):795-8
AD - Department of Pathology, Ball Memorial Hospital, 2401 University Avenue,
Muncie, IN 47303, USA. wuh@palab.com
OBJECTIVE: To assess the significance of benign exfoliated endometrial
epithelial or stromal cells on cervicovaginal Pap smears obtained from
postmenopausal women not receiving exogenous hormones. STUDY DESIGN: A
computerized search of the cytology database at two institutions was
performed for a five-year period, and all cervical cytology cases from
postmenopausal patients diagnosed with benign endometrial cells were
identified. Those cases with histologic follow-up within 12 months of
the original cytologic evaluation were selected for analysis, and their
cytology and surgical pathology slides were reviewed. RESULTS: A total
of 227 postmenopausal women with benign endometrial cells were
identified. Of the 61 patients with histologic follow-up, 25 (41%) had
significant endometrial diseases, including hyperplasia without atypia
(11), atypical endometrial hyperplasia (5), well-differentiated
adenocarcinoma (8) and high grade serous carcinoma (1). Benign
diagnoses, including atrophy (15), weakly proliferative endometrium (9)
and proliferative endometrium (6), were noted in 30 patients (49%).
Endometrial polyp was identified in three patients (5%). There were
three cases of nondiagnostic histologic specimens that lacked
endometrial tissue (5%). Two of nine women (22%) with proven carcinoma
were asymptomatic. CONCLUSION: The diagnosis of endometrial cells,
cytologically benign, in a postmenopausal woman not receiving hormone on
Pap smears is associated with a significant number of cases of
endometrial hyperplasia, atypical hyperplasia and carcinoma.
5
UI - 11584486
AU - Dunn TS; Stamm CA; Delorit M; Goldberg G
TI -
Clinical pathway for evaluating women with abnormal uterine bleeding.
SO - J Reprod Med 2001 Sep;46(9):831-4
AD - Departments of Obstetrics and Gynecology, Denver Health Medical Center,
University of Colorado Health Science Center, 777 Bannock Street, M/C
0660, Denver, CO 80204, USA. tdunn@dhha.org
OBJECTIVE: To devise a clinical pathway for evaluating women with
abnormal uterine bleeding. STUDY DESIGN: One thousand women with the
complaint of abnormal uterine bleeding were enrolled. All would have
undergone endometrial biopsy based on older recommendations. The
patients followed a clinical pathway to determine if an endometrial
biopsy was necessary. The pathway divided women into the categories of
premenopausal, postmenopausal, low risk and high risk. If one risk
factor was present, the patient underwent endometrial biopsy. If there
were no risk factors, the patient continued down the pathway with
medical therapy. RESULTS: Five hundred seventy endometrial biopsies were
performed. Five cases of endometrial cancer and three of complex
atypical hyperplasia, both in the postmenopausal, high-risk group, were
discovered. Subsequent reviews revealed that no cases of endometrial
cancer were missed or developed in the two years following the initial
complaint. CONCLUSION: Utilization of a clinical pathway reduced the
number of endometrial biopsies by 50%. The introduction of clinical
pathways at our institution was done successfully in the evaluation of
abnormal uterine bleeding.
6
UI - 11788613
AU - Hale GE; Hughes CL; Cline JM
TI -
Endometrial cancer: hormonal factors, the perimenopausal "window of
risk," and isoflavones.
SO - J Clin Endocrinol Metab 2002 Jan;87(1):3-15
AD - Center for Women's Health, Cedars-Sinai Medical Center, Los Angeles,
California 90048, USA.
7
UI - 11784412
AU - McCann SE; Marshall JR; Brasure JR; Graham S; Freudenheim JL
TI -
Analysis of patterns of food intake in nutritional epidemiology: food
classification in principal components analysis and the subsequent
impact on estimates for endometrial cancer.
SO - Public Health Nutr 2001 Oct;4(5):989-97
AD - Department of Social and Preventive Medicine, State University of New
York at Buffalo, NY 14214, USA. mccann@acsu.buffalo.edu.
OBJECTIVE: To assess the effect of different methods of classifying food
use on principal components analysis (PCA)-derived dietary patterns, and
the subsequent impact on estimation of cancer risk associated with the
different patterns. METHODS: Dietary data were obtained from 232
endometrial cancer cases and 639 controls (Western New York Diet Study)
using a 190-item semi-quantitative food-frequency questionnaire. Dietary
patterns were generated using PCA and three methods of classifying food
use: 168 single foods and beverages; 56 detailed food groups, foods and
beverages; and 36 less-detailed groups and single food items. RESULTS:
Classification method affected neither the number nor character of the
patterns identified. However, total variance explained in food use
increased as the detail included in the PCA decreased (approximately 8%,
168 items to approximately 17%, 36 items). Conversely, reduced detail in
PCA tended to attenuate the odds ratio (OR) associated with the healthy
patterns (OR 0.55, 95% confidence interval (CI) 0.35-0.84 and OR 0.77,
95% CI 0.49-1.20, 168 and 36 items, respectively) but not the high-fat
patterns (OR 0.95, 95% CI 0.57-1.58 and OR 0.85, 0.51-1.40, 168 and 36
items, respectively). CONCLUSIONS: Greater detail in food-use
information may be desirable in determination of dietary patterns for
more precise estimates of disease risk.
8
UI - 11774741
AU - Yokoyama Y; Wan X; Shinohara A; Takahashi Y; Tamaya T
TI -
Hammerhead ribozymes to modulate telomerase activity of endometrial
carcinoma cells.
SO - Hum Cell 2001 Sep;14(3):223-31
AD - Department of Obstetrics and Gynecology, Gifu University.
yokoyama@cc.gifu-u.ac.jp
Telomerase is an excellent target molecule for cancer therapy, though
any effective agents have never been developed in human subjects. We
designed a variety of hammerhead ribozymes against human telomerase RNA
(hTR) and hTERT mRNA and studied their possibility as a tool for cancer
therapy. To search promising target site of hTR, the catalytic actiuity
of 3 kinds of hammerhead ribozymes was studied in cell-free system. They
showed equivalent catalytic activity, but only 36-ribozyme, which was
designed to cleave the template region of hTR, revealed telomerase
inhibitory activity in an endometrial carcinoma cell line. Among
hTERT-mRNA-targeted ribozymes, the ribozyme to cleave 13 nucleotides
downstream from the 5'-end of hTERT mRNA (13-ribozyme) exhibited the
strongest telomerase-inhibitory activity, and the ribozyme to cleave 59
nucleotides upstream from the poly(A) tail showed clear activity. Stable
transfection studies confirmed that the 36-ribozyme as well as the
13-ribozyme suppressed telomerase. These observations suggest that the
template region of hTR and 5'end of hTERT mRNA are promising target
sites for ribozymes to reduce telomerase activity.
9
UI - 11782363
AU - Arnold JT; Lessey BA; Seppala M; Kaufman DG
TI -
Effect of normal endometrial stroma on growth and differentiation in
Ishikawa endometrial adenocarcinoma cells.
SO - Cancer Res 2002 Jan 1;62(1):79-88
AD - Department of Laboratory Pathology and Medicine, Division of
Reproductive Endocrinology and Infertility, University of North Carolina
at Chapel Hill, North Carolina 27599, USA. jarnold@mail.nih.gov
Endometrial cancer is characterized by alterations in the stromal cells
and the supporting extracellular matrix in addition to the intrinsic
alterations of the malignant epithelial cells. We have developed a cell
culture model that demonstrates the role of stromal cells in the
regulation of proliferation, hormone responsiveness, and differentiation
of an endometrial adenocarcinoma cell line (Ishikawa). Conditioned
medium (CM) was collected from normal primary human endometrial stromal
cells grown on plastic or within the basement membrane extract,
Matrigel. The CM produced by stromal cells cultured in contact with
Matrigel markedly inhibited Ishikawa cell proliferation compared with CM
from stromal cells cultured on plastic. Ishikawa cell proliferation
varied with steroid hormone treatment in the presence of CM from stromal
cells embedded in Matrigel. When the Ishikawa cells were placed in
coculture in contact with stromal cells in Matrigel, production of a
differentiated epithelial secretory product, glycodelin, was induced.
Gene expression of stromal cell hormone receptors, growth factors, and
integrins was analyzed by reverse transcription-PCR in the presence of
Matrigel to determine the potential factors involved in stromal
regulatory function. These combined studies imply that the phenotype of
the Ishikawa cells can be induced to differentiate to more closely
resemble normal endometrial epithelium by reintroduction of stromal
factors and appropriate extracellular matrix. Additionally, the study
shows that basement membrane proteins influence the regulatory function
of stromal cells as they mediate epithelial cell growth.
10
UI - 11587008
AU - Goldstein RB; Bree RL; Benson CB; Benacerraf BR; Bloss JD; Carlos R;
TI -
Fleischer AC; Goldstein SR; Hunt RB; Kurman RJ; Kurtz AB; Laing FC;
Parsons AK; Smith-Bindman R; Walker J
Evaluation of the woman with postmenopausal bleeding: Society of
Radiologists in Ultrasound-Sponsored Consensus Conference statement.
SO - J Ultrasound Med 2001 Oct;20(10):1025-36
AD - Department of Radiology, University of California, San Francisco,
94143-0628, USA.
OBJECTIVES: A panel of 14 physicians practicing medicine in the United
States with expertise in radiology, obstetrics and gynecology,
gynecologic oncology, hysteroscopy, epidemiology, and pathology was
convened by the Society of Radiologists in Ultrasound to discuss the
role of sonography in women with postmenopausal bleeding. Broad
objectives of this conference were (1) to advance understanding of the
utility of different diagnostic techniques for evaluating the
endometrium in women with postmenopausal bleeding; (2) to formulate
useful and practical guidelines for evaluation of women with
postmenopausal bleeding, specifically as it relates to the use of
sonography; and (3) to offer suggestions for future research projects.
SETTING: October 24 and 25, 2000, Washington, DC, preceding the annual
Society of Radiologists in Ultrasound Advances in Sonography conference.
PROCEDURE: Specific questions to the panel included the following: (1)
What are the relative effectiveness and cost-effectiveness of using
transvaginal sonography versus office (nondirected) endometrial biopsy
as the initial examination for a woman with postmenopausal bleeding? (2)
What are the sonographic standards for evaluating a woman with
postmenopausal bleeding? (3) What are the abnormal sonographic findings
in a woman with postmenopausal bleeding? (4) When should saline infusion
sonohysterography or hysteroscopy be used in the evaluation of
postmenopausal bleeding? (5) Should the diagnostic approach be modified
for patients taking hormone replacement medications, tamoxifen, or other
selective estrogen receptor modulators? CONCLUSIONS: Consensus
recommendations were used to create an algorithm for evaluating women
with postmenopausal bleeding. All panelists agreed that because
postmenopausal bleeding is the most common presenting symptom of
endometrial cancer, when postmenopausal bleeding occurs, clinical
evaluation is indicated. The panelists also agreed that either
transvaginal sonography or endometrial biopsy could be used safely and
effectively as the first diagnostic step. Whether sonography or
endometrial biopsy is used initially depends on the physician's
assessment of patient risk, the nature of the physician's practice, the
availability of high-quality sonography, and patient preference. Similar
sensitivities for detecting endometrial carcinoma are reported for
transvaginal sonography when an endometrial thickness of greater than 5
mm is considered abnormal and for endometrial biopsy when "sufficient"
tissue is obtained. Currently, with respect to mortality, morbidity, and
quality-of-life end points, there are insufficient data to comment as to
which approach is more effective. The conference concluded by
identifying several important unanswered questions and suggestions that
could be addressed by future research projects.
11
UI - 11587009
AU - Doubilet PM
TI -
Society of Radiologists in Ultrasound Consensus Conference statement on
postmenopausal bleeding.
SO - J Ultrasound Med 2001 Oct;20(10):1037-42
AD - Brigham and Women's Hospital, Boston, Massachusetts, USA.
12
UI - 11714111
AU - Newcomer LM; Newcomb PA; Trentham-Dietz A; Storer BE
TI -
Hormonal risk factors for endometrial cancer: modification by cigarette
smoking (United States).
SO - Cancer Causes Control 2001 Nov;12(9):829-35
AD - Cancer Prevention Research Program, Fred Hutchinson Research Center,
Seattle, WA 98109-1024, USA.
OBJECTIVES: To evaluate whether smoking modifies the risk of endometrial
cancer associated with body mass index (BMI), postmenopausal hormone
use, and other hormonal factors. METHODS: Using multivariate adjusted
models we examined interview data from a population-based case-control
study of Wisconsin women (n = 740 cases, n = 2,372 controls). RESULTS:
The relative risk for endometrial cancer associated with current smoking
was 0.8 (95% CI: 0.6-1.0) compared to never smokers. No clear
dose-response relationship was evident for pack-years smoked. When
examined according to smoking status the risk associated with the
highest quartile of BMI seemed to be greater among non-smokers (OR =
3.6, 95% CI: 2.4-5.3) than among current smokers (OR = 2.8, 95% CI:
1.4-5.6). Among postmenopausal women the risk associated with current
use of postmenopausal hormones appeared to be greater among non-smokers
(OR = 3.3, 95% CI: 2.3-4.9) than among current smokers (OR = 2.7. 95%
CI: 1.3-5.5). Risk for long-term use (10 or more years) compared with
never users was 8.3 (95% CI: 4.6-15.1) among never smokers and 2.5 (95%
CI: 0.8-7.9) among current smokers. The risk associated with
non-insulin-dependent diabetes was greater among non-smokers (OR = 2.5,
95% CI: 1.7-3.6) than current smokers (OR = 1.1, 95% CI: 0.4-3.1). There
was no modifying effect of smoking on the risk associated with parity.
CONCLUSION: These results suggest that smoking moderates the risk
associated with endometrial cancer among women at greatest risk,
specifically women who are obese or who use postmenopausal hormones.
13
UI - 11779615
AU - Lowe MP; Bender D; Sood AK; Davis W; Syrop CH; Sorosky JI
TI -
Two successful pregnancies after conservative treatment of endometrial
cancer and assisted reproduction.
SO - Fertil Steril 2002 Jan;77(1):188-9
AD - Department of Obstetrics and Gynecology, University of Iowa College of
Medicine, Iowa City, Iowa 52242, USA.
OBJECTIVE: To report successful pregnancies after conservative
management of FIGO grade I adenocarcinoma of the endometrium. DESIGN:
Retrospective chart review. SETTING: University-based assisted
reproduction and oncology units. PATIENT(S): One patient who had two
separate pregnancies. Intervention(s): High-dose progestin (megestrol
acetate) therapy for adenocarcinoma, followed by assisted reproduction
with donor oocyte. MAIN OUTCOME MEASURE(S): Histologic evaluation of
endometrium after megestrol acetate and at completion of childbearing,
and successful pregnancies and deliveries. RESULT(S): The patient had
complete resolution of adenocarcinoma with progestin therapy and
successful delivery of two pregnancies after assisted reproduction.
CONCLUSION(S): Conservative management of International Federation of
Gynecology and Obstetrics grade I adenocarcinoma of the endometrium
allows preservation of childbearing.
14
UI - 11588939
AU - Sturdee DW
TI -
Endometrial safety.
SO - Climacteric 2001 Sep;4(3):177-8
15
UI - 11778238
AU - Chao H; Sun J; Lu S
TI -
[Methylation and expression of the p16 gene in endometrial carcinoma]
SO - Zhonghua Zhong Liu Za Zhi 2000 May;22(3):228-31
AD - Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking
Union Medical College, Beijing 100021, China.
OBJECTIVE: To analyse the relationship between methylation status of the
5' CpG island and mRNA expression of the p16 gene in endometrial
carcinoma. METHODS: Methylation status of p16 gene was determined by
methylation-sensitive restriction enzymes, PCR and p16 mRNA expression
was evaluated by RT-PCR in a series of 8 specimens with normal
endometrium(NE), 6 with simple and complex hyperplasia(SCH), 6 with
atypical hyperplasia (AH) and 38 with endometrial carcinoma(EC).
RESULTS: Eight specimens of NE displayed no methylation and showed
normal expression of the p16 mRNA. In 1 of the 6 AH and 13 of the
38(34.21%) EC, there was methylation of p16 exon 1; 5 of the 6 SCH
showed overexpression of p16 mRNA, 4 of the 6 AH and 27 of the 38
(71.05%) EC exhibited decrease or loss of p16 mRNA expression.
CONCLUSION: Hypermethylation of p16 gene is an early event of
endometrial carcinogenesis and is associated with the progression of
endometrial carcinoma. Hypermethylation is highly correlated with
inhibition of p16 gene transcription.
16
UI - 11550800
AU - Semczuk A; Skomra D; Cybulski M; Jakowicki JA
TI -
Immunohistochemical analysis of MIB-1 proliferative activity in human
endometrial cancer. Correlation with clinicopathological parameters,
patient outcome, retinoblastoma immunoreactivity and K-ras codon 12
point mutations.
SO - Histochem J 2001 Apr;33(4):193-200
AD - IInd Department of Gynecological Surgery, Lublin University School of
Medicine, Poland.
To test the prognostic utility of MIB-1 in human endometrial neoplasias,
the proliferative activities of fifty-two endometrial carcinomas
obtained from Polish women were assessed. We also investigated the
relationship between the MIB-1 Proliferative Index and the well-known
clinicopathological features of cancer (clinical stage, histological
type, histological grade, depth of myometrial invasion), patient's age,
overall survival, retinoblastoma immunostaining and K-ras codon 12 point
mutations. The mean MIB-1 Proliferation Index was 43.8%, with a median
of 36.0%. Due to the great intratumour heterogeneity of the
immunoreaction, the Index ranged from 0% to 98%. A significant
relationship was noted between MIB-1 expression and histological grading
(p = 0.0004) and myometrial invasion of cancer (p = 0.01). Multivariate
Cox regression demonstrated that the clinical stage was the only
independent prognostic factor during follow-up (p = 0.025). There was a
tendency towards a poorer outcome for women with a Proliferative Index
of > 31% than for patients whose Index was < or = 31%; the difference,
however, did not reach significance (p = 0.25; log-rank test).
Interestingly, uterine cancers lacking retinoblastoma protein expression
had a mean MIB-1 Proliferation Index that was nearly twice as high as in
those neoplasias that stained positively for retinoblastoma (70.33% and
42.14%, respectively; p = 0.09; Mann-Whitney-U test). There were no
significant differences between K-ras codon 12 point mutation-positive
and -negative endometrial carcinomas regarding the proliferative
activity of the cancer (mean Indexes 47.6% and 43.8%, respectively; p =
0.66, Mann-Whitney-U test). Our data support the view that MIB-1
proliferative activity was significantly increased with a decrease of
the histological grading and with the myometrial invasion of human
endometrial cancer.
17
UI - 11603220
AU - Peiro G; Diebold J; Baretton GB; Kimmig R; Lohrs U
TI -
Cellular apoptosis susceptibility gene expression in endometrial
carcinoma: correlation with Bcl-2, Bax, and caspase-3 expression and
outcome.
SO - Int J Gynecol Pathol 2001 Oct;20(4):359-67
AD - Institute of Pathology, Klinikum Grosshadern, Ludwig-Maximilians
University Munich, Munchen, Germany.
Deregulation of proliferation and apoptosis is known to contribute to
neoplastic transformation and growth. Using specific antibodies for the
cellular apoptosis susceptibility (CAS) gene, caspase-3, Bcl-2, and Bax,
we examined the protein expression in 89 endometrial carcinomas and in
56 samples of nonneoplastic adjacent endometrium for comparison.
Immunostaining results were scored with regard to approximate percentage
of positive tumor cells (< 10%, 10% to 50%, > 50%) and relative
immunostaining intensity (1+, 2+, 3+). In nonneoplastic endometrium, CAS
protein was expressed in 70.6%, Bax in 64%, caspase-3 in 52%, and Bcl-2
in 87%. In neoplastic tissue, CAS was present in 93% of the tumors, Bax
in 88%, caspase-3 in 77%, and Bcl-2 in 51%. Bcl-2:Bax ratio was > 1 in 9
cases (10%). In cases of atrophy (n = 24) and simple (n = 10) and
complex (n = 22) hyperplasia in the adjacent endometrium, lower levels
of expression compared with carcinoma were observed for CAS (p = 0.003),
caspase-3 (p = 0.034), and Bax (p = 0.04) and higher levels for Bcl-2,
although for this protein the results were not statistically significant
(p = 0.32). There was no association between immunoscores and FIGO
stage. High caspase-3 levels were seen in endometrioid tumor type (p =
0.017). CAS expression was higher in grade 3 tumors (p = 0.002) and
older patients (p = 0.013). All tumors of younger patients (< 50 years)
were Bcl-2 negative (p = 0.037). Caspase-3 correlated positively with
CAS (p = 0.008), Bax (p = 0.04), and low Bcl-2:Bax ratio (p = 0.043),
and inversely (as a trend) with Bcl-2 (p = 0.056). Survival analysis
(Kaplan-Meier and Cox regression) established a strong association
between prognosis and stage, grade, and histologic type (all p < or =
0.0036). In addition, shorter survival was observed for patients whose
tumors contained > 50% of positive cells for caspase-3 (p = 0.024) or
for CAS (p = 0.04). Age, Bcl-2, Bax, and Bcl-2:Bax ratio did not provide
prognostic information. Our results suggest a role of CAS, Bcl-2, Bax,
and caspase-3, which are apparently involved in the progressive
deregulation of proliferation and apoptosis leading from simple and
complex hyperplasia to carcinoma. In addition, CAS and caspase-3 protein
levels may be useful markers in predicting the outcome of the patients.
18
UI - 11603221
AU - Watanabe Y; Nakajima H; Nozaki K; Ueda H; Obata K; Hoshiai H; Noda K
TI -
Clinicopathologic and immunohistochemical features and microsatellite
status of endometrial cancer of the uterine isthmus.
SO - Int J Gynecol Pathol 2001 Oct;20(4):368-73
AD - Department of Obstetrics and Gynecology, Kinki University School of
Medicine, 377-2 Ohno-Higashi, Osakasayama, Osaka 589-8511 Japan.
watanabe@med.kindai.ac.jp
To clarify the clinicopathologic, molecular, and immunohistochemical
characteristics of uterine isthmic endometrial cancer (UIE), we examined
13 cases of UIE and compared them with 33 cases of endometrial cancer of
the uterine corpus (UCE) with respect to clinicopathologic factors, the
expression of p53, the estrogen receptor (ER) and the progesterone
receptor (PR) status, DNA ploidy, and microsatellite instability (MSI).
Five (38.4%) of the UIE patients had stage I, two (15.4%) had stage II,
and six (46.2%) had stage III disease (FIGO 1988). Myometrial invasion
was confirmed in 92.3% of the UIE patients, and these patients had a
higher (p < 0.05) frequency of > 50% myometrial invasion (46.2%) than
the patients with UCE (15.2%). Moreover, the UIE patients had a higher
frequency of positive peritoneal cytology (p < 0.05) and pelvic lymph
node metastases (p < 0.05). No UIE tumors exhibited MSI, and the tumors
in these patients had a higher expression of p53 (p < 0.01), a lower
expression of ER (p < 0.05) and PR (p < 0.05), and a higher frequency of
DNA aneuploidy (p < 0.01) than the UCE tumors. These findings suggest
that the UIE is clearly different from UCE in the clinicopathologic,
immunohistochemical features, and microsatellite status.
19
UI - 11603226
AU - Levine PH; Abou-Nassar S; Mittal K
TI -
Extrauterine low-grade endometrial stromal sarcoma with florid
endometrioid glandular differentiation.
SO - Int J Gynecol Pathol 2001 Oct;20(4):395-8
AD - Department of Pathology, New York University Medical Center, Bellevue
Hospital, New York, NY, USA.
Endometrial stromal sarcoma of the uterus (ESS) is a rare lesion that
can cause diagnostic difficulty especially when it presents with unusual
histologic features such as diffuse endometrioid glandular
differentiation. Only three such cases have been reported, all primary
in the uterus. We report the first case of an extrauterine low-grade ESS
with extensive glandular differentiation that appeared to arise in
endometriosis.
20
UI - 11759963
AU - Sinawat S; Chiyabutra T; Kleabkaew P
TI -
Detection of endometrial cancer in asymptomatic postmenopausal breast
cancer patient treated with tamoxifen: a case report.
SO - J Med Assoc Thai 2001 Jul;84(7):1033-6
AD - Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen
University, Thailand.
Breast cancer is among the commonest malignancies in women and tamoxifen
has been widely used for more than two decades for treatment of breast
cancer. It has been known that long term use of tamoxifen significantly
increases the risk of endometrial cancer but there is no generally
accepted recommendation regarding the surveillance of endometrial
pathologies in breast cancer patients taking tamoxifen. Although the
incidence of endometrial cancer associated with tamoxifen use is not
high, the risk is true and these patients could be helped by screening
methods such as transvaginal ultrasonogrphy. We report here a case of
endometrial cancer detected by transvaginal 2D scan in an asymptomatic
postmenopausal woman taking tamoxifen.
21
UI - 11795358
AU - Goldstein SR
TI -
The effect of SERMs on the endometrium.
SO - Ann N Y Acad Sci 2001 Dec;949():237-42
AD - Department of Obstetrics and Gynecology, New York University School of
Medicine, New York 10016, USA. Steven.Goldstein@Med.Nyu.Edu
Tamoxifen, the first clinically available SERM, was developed in 1966
and approved by the FDA (United States Food and Drug Administration) in
1978. It is the most prescribed antineoplastic drug in the world, with
approximately 10 million women-use-years of experience. Tamoxifen has
proved efficacious in all settings of breast cancer. However, in the
mid-to-late 1980s, a series of letters to the editor and case reports
announced an association between tamoxifen therapy in women with breast
cancer and the development of endometrial carcinoma. Subsequently, in
1998, the observation of a significant 49% reduction in invasive breast
cancer relative to placebo in a cohort of women at increased risk for
the disease resulted in the early stopping of the National Surgical
Adjuvant Breast and Bowel Project's (NSABP) P-1: Breast Cancer
Prevention Trial (BCPT). Importantly, this was the first time that
information became available about the effects of tamoxifen in healthy
women, that is, women who did not already have breast cancer. In this
healthy population, the relative risk of developing endometrial
carcinoma in the tamoxifen arm was 2.54, although when stratified by
age, in women over 50, the risk grew to 4.01. Thus, the risk appears to
be confined to women over 50 because, in contrast, in women under 50
there was no statistically significant increase in the risk of
endometrial carcinoma.
22
UI - 11814503
AU - Horowitz NS; Peters WA 3rd; Smith MR; Drescher CW; Atwood M; Mate TP
TI -
Adjuvant high dose rate vaginal brachytherapy as treatment of stage I
and II endometrial carcinoma.
SO - Obstet Gynecol 2002 Feb;99(2):235-40
AD - The Swedish Medical Center, Seattle, Washington, USA.
horowitzn@msnotes.wustl.edu
OBJECTIVE: To evaluate the efficacy of high dose rate vaginal
brachytherapy in the treatment of International Federation of Gynecology
and Obstetrics stage IB, IC, and II endometrial carcinoma after surgical
staging and complete lymphadenectomy. METHODS: All patients with stage
IB, IC, or II adenocarcinoma or adenosquamous carcinoma of the
endometrium who received postoperative high dose rate vaginal
brachytherapy at our institution between June 1, 1989, and June 1, 1999,
were eligible. High dose rate vaginal brachytherapy was delivered in
three fractions of 700 cGy. Retrospective chart review was performed.
Kaplan-Meier estimates were calculated for disease-free and overall
survival. RESULTS: One hundred sixty-four women were identified.
Fifty-six percent had stage IB disease, 30% had stage IC disease, and
14% had stage II disease. Approximately one third of patients had
high-grade lesions and nearly 40% had deep myometrial invasion. Median
follow-up was 65 months (range 6-142 months). To date, 14 patients have
had recurrence; 2 at the vaginal apex, 9 at distant sites, 1 at the
pelvic sidewall, 1 simultaneously in the pelvis and at a distant site,
and 1 at an unknown site. Both patients with vaginal apex recurrences
had salvage therapy and are now free of disease. The overall 5-year
survival and disease-free survival rates were 87% and 90%, respectively.
There were no Radiation Therapy Oncology Group grade 3 or 4 toxicities.
High dose rate vaginal brachytherapy was approximately $1,000 less
expensive than external-beam whole-pelvic radiation. CONCLUSIONS:
Adjuvant high dose rate vaginal brachytherapy in thoroughly staged
patients with intermediate-risk endometrial carcinoma provides excellent
overall and disease-free survival with less toxicity and at less cost
compared with whole-pelvic radiation.
23
UI - 11843398
AU - Gornall RJ; Standfield N; deSouza NM; Aachi VR; McIndoe GA
TI -
Resection of recurrent bulky gynaecological side wall malignancy with
iliac vessel reconstruction.
SO - BJOG 2001 Dec;108(12):1305-8
AD - Institute of Obstetrics and Gynaecology, Imperial College School of
Medicine, Hammersmith Hospital, London, UK.
24
UI - 11695807
AU - Ampil FL; Caldito G; Unger J; Connor P; Pelser R
TI -
Can intermediate-risk node-negative patients with stage I corpus cancer
do without posthysterectomy radiotherapy? Review of a 13-year
experience.
SO - Eur J Gynaecol Oncol 2001;22(4):269-72
AD - Department of Radiology, Louisiana State University Health Sciences
Center Shreveport 71130, USA.
A retrospective comparative study of 41 patients with stage I corpus
cancer, negative surgical staging, and adverse pathological features
either treated or untreated by posthysterectomy radiotherapy (PHR)
during a 13-year period was undertaken. The patients were matched for
age, intermediate-risk classification, number of sampled nodes and the
presence of coexisting illness. After complete follow-up, there was no
significant difference in outcome between the patient groups. Unless it
can be shown definitely that PHR is beneficial, its use in
intermediate-risk node-negative stage I corpus cancer patients must be
seriously questioned.
25
UI - 11604195
AU - Nasu K; Kai K; Fujisawa K; Takai N; Nishida Y; Miyakawa I
TI -
Expression of cathepsin L in normal endometrium and endometrial cancer.
SO - Eur J Obstet Gynecol Reprod Biol 2001 Nov;99(1):102-5
AD - Department of Obstetrics and Gynecology, Oita Medical University,
Hasama-machi, Oita 879-5593, Japan. nasu@oita-med.ac.jp
OBJECTIVE: To evaluate the expression of cathepsin L in normal
endometrium and endometrial adenocarcinoma. STUDY DESIGN: Tissue from
eight cases of G1 and eight of G2 endometrioid adenocarcinoma, and 15
normal endometrial specimens were examined by immunohistochemistry.
RESULTS: In the normal endometrium, cathepsin L was expressed in a few
cell layers of the apical part of the glandular epithelium throughout
the menstrual cycle. In the carcinomas, there was an inverse correlation
between the grade of tumor and the cathepsin L expression. CONCLUSION:
Cathepsin L expression may cease during endometrial carcinogenesis and
its expression may be less important in tumor progression than it is in
tumors of other tissues.
26
UI - 11836298
AU - Li XH; Li H; Xiao ZJ; Piao YS
TI -
Divergent effects of retinoic acids on the expression of ERalpha and
17beta-hydroxysteroid dehydrogenase type 2 in endometrial carcinoma
cells (RL 95-2).
SO - J Clin Endocrinol Metab 2002 Feb;87(2):640-9
AD - State Key Laboratory of Reproductive Biology, Institute of Zoology,
Chinese Academy of Sciences, Beijing 100080, China.
The effects of E2 are dependent on ERs and local E2 concentration in
target cells. Modulation of intracellular E2 concentration involves the
action of 17beta-hydroxysteroid dehydrogenase (17HSD) type 2, the enzyme
converting E2 to estrone. In the present study, the influence of RAs on
the growth of endometrial cancer cell line RL 95-2 as well as the
expression of ERs and 17HSD type 2 have been investigated. It was found
that RAs repress the growth of RL 95-2 cells, which express all subtypes
of RXR and RAR, as examined by RT-PCR. Also, quantitative RT-PCR
analysis showed that both ERalpha and ERbeta are present in RL 95-2
cells, and Western blot assay further revealed that ERalpha expression
was decreased by all trans-RA treatment. In contrast, RAs induced 17HSD
type 2 mRNA expression in a dose- and time-dependent fashion. This
stimulatory effect was also detected at the level of in vivo oxidative
17HSD activity in cultured cells. On the other hand, the abundance of
17HSD type 2 mRNA was not altered by RAs in cultured normal epithelial
cells isolated from human early- and late-secretory endometrium. The
data indicate that RAs have an inhibitory effect on the growth of RL
95-2 cells and a cross-talk with the estrogen pathway in
estrogen-responsive endometrial cancer cells.
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