DOCSLIB.ORG

Pregnancy and Oncologic Outcomes After Fertility-Sparing Management for Early Stage Endometrioid Endometrial Cancer

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Pregnancy and Oncologic Outcomes After Fertility-Sparing Management for Early Stage Endometrioid Endometrial Cancer Original Article Int J Gynecol Cancer: first published as 10.1136/ijgc-2018-000036 on 7 January 2019. Downloaded from Pregnancy and oncologic outcomes after fertility-sparing management for early stage endometrioid endometrial cancer Su Hyun Chae,1 Seung-Hyuk Shim,1 Sun Joo Lee,1 Ji Young Lee,1 Soo-Nyung Kim,1 Soon-Beom Kang2 1Department of Obstetrics and HIGHLIGHTS Gynecology, Konkuk University • Pregnancy after fertility-sparing management can be successful. School of Medicine, Seoul, Korea • Grade 2 endometrial cancer might be a poor prognostic factor of fertility outcomes. 2Gynecologic Cancer Center, • Pregnancy itself slows the recurrence of endometrial cancer after complete remission. Department of Obstetrics and Gynecology, Konkuk University incidence has been gradually increasing in pre-men- Medical Center, Seoul, Korea ABSTRACT Objective Hormonal management is an alternative opausal women in recent years. Early detection is treatment for preserving fertility in patients with presumed possible because symptoms such as vaginal bleeding Correspondence to 1 3 6 7 Seung-Hyuk Shim, Department early stage endometrioid endometrial cancer. This study are common in early endometrial cancer. In this of Obstetrics and Gynecology, aimed to define the pregnancy and oncologic outcomes regard, fertility-sparing therapy in fertile women with Konkuk University School of and factors of successful conception after hormone early stage EC has recently been enforced.8 The gold Medicine, Seoul 05030, Korea; therapy for endometrioid endometrial cancer. standard EC management is hysterectomy and bilat- nastassja@ hanmail. net Methods We retrospectively analyzed patients presumed eral salpingo-oophorectomy with or without pelvic/ to have stage IA, grade 1–2 endometrioid endometrial para-aortic lymph node dissection.9 However, for Soon-Beom Kang, Gynecologic cancer who underwent fertility-sparing treatment. Cancer Center, Department Concurrent medroxyprogesterone and levonorgestrel- younger patients with early stage endometrioid EC of Obstetrics and Gynecology, release intra-uterine devices were used for treatment. who want to preserve fertility, this operation would Konkuk University Medical decrease their quality of life and remove any chance Center, Seoul, Korea; The pregnancy outcomes and oncologic outcomes were 20120097@ kuh. ac. kr compared between the pregnant and non-pregnant groups. of pregnancy. Results Seventy-one patients presumed to have stage IA, For these patients, fertility-sparing manage- grade 1–2 endometrioid endometrial cancer had complete ment with medroxyprogesterone acetate and levo- Received 24 June 2018 remission, and 49 of them tried to conceive. Twenty-two norgestrel-release intra-uterine devices has been http://ijgc.bmj.com/ Revised 5 September 2018 (44.9%) patients became pregnant; the total number of 10–16 Accepted 17 September 2018 recommended in several studies. Oral medroxy- pregnancies was 30. These pregnancies resulted in seven progesterone acetate use and levonorgestrel-release abortions (23.3%), one pre-term birth (3.3%), and 20 full- intra-uterine device insertion can prevent progres- term births (66.6%). The total live birth rate was 66.6 % sion of endometrial cancer and induce endometrial (20/30). The median duration of hormonal treatment was 17 11.9 months (range 4–49) and 12.0 months (range 3–35) regression. Patients were advised to try to conceive immediately after complete response following in the pregnant and non-pregnant groups, respectively. on September 27, 2021 by guest. Protected copyright. On multivariate analysis, age, body mass index, treatment medroxyprogesterone acetate treatment if pregnancy duration, medroxyprogesterone dose, and number of was desired. Although there have been some reports dilatation and curettage biopsies were not significantly of pregnancy outcomes in these patients, there has associated with pregnancy failure, but the association been little research into what factors are associated with grade (OR 6.2, 95% CI 1.0 to 38.9; P<0.05) was with successful pregnancies.18–21 The aim of this study statistically significant. The median disease-free survival was to define the pregnancy outcomes and factors duration was 26 months (range 20–38) and 12 months of successful conception after hormone therapy for (range 4–48) in the pregnant and non-pregnant groups, respectively (P<0.05, log-rank test). endometrioid endometrial cancer. Moreover, the Conclusions A lower grade might be a positive factor for oncologic outcomes were compared between the future pregnancy. Moreover, successful pregnancy might pregnant and non-pregnant groups. be a factor in preventing recurrence. © IGCS and ESGO 2019. No commercial re-use. See rights and permissions. Published by INTRODUCTION BMJ. Endometrial cancer is the most common gynecolog- METHODS 1 2 To cite: Chae SH, Shim S-H, ical cancer in the USA and Europe. Its incidence We retrospectively analyzed patients with presumed Lee SJ, et al. Int J Gynecol in Korea is rising gradually.3–5 Endometrial cancer stage IA, grade 1–2 endometrioid EC patients who Cancer 2019;29:77–85. is common in post-menopausal women, but its underwent fertility-sparing treatment between Chae SH, et al. Int J Gynecol Cancer 2019;29:77–85. doi:10.1136/ijgc-2018-000036 77 Original Article Int J Gynecol Cancer: first published as 10.1136/ijgc-2018-000036 on 7 January 2019. Downloaded from Figure 1 Outcome of patients with endometrial cancer after hormone treatment. January 2005 and December 2017. Our institutional review board Persistent disease was defined as no regression within 6 months approved this study (KUH1040065). from the initial treatment. Progressive disease was defined as a FIGO stage or grade upgrade that occurred during follow-up. Increasing Patients the medroxyprogesterone acetate dose to 1000 mg was considered Patients with endometrioid endometrial cancer were selected by if the patient had 6 to 9 months of persistent disease in follow-up pathologic confirmation with dilatation and curettage biopsy (D&C). D&Cs. Recurrence was diagnosed if carcinoma was observed on Our gynecologic oncology pathologist reviewed all pathology slides, pathology after complete remission.30 An anti-adhesive medication even those from outside hospitals. All patients underwent a full (poloxamer) was used in the endometrial cavity every time D&C workup, such as abdominal-pelvis CT, abdominal-pelvis with liver was performed.31 32 Treatment was stopped when two serial eval- coverage MRI, positron emission tomography-CTscan, mammog- uations revealed no evidence of carcinoma on pathology. Hormone http://ijgc.bmj.com/ raphy, cancer antigen (CA) 125, and other laboratory tests. After treatment and levonorgestrel-release intra-uterine device insertion workup, patients who were presumed to have stage IA endome- were terminated if a patient with complete remission wanted to trioid endometrial cancer with grade 1 or 2 were included. Myome- conceive. During fertility treatment or the conception trial period, trial invasion was evaluated with MRI. Combination of T2-weighted follow-up was scheduled every 3 months for a general gynecologic imaging with contrast-enhanced T1-weighted imaging including examination and transvaginal ultrasound. Endometrial pathology dynamic contrast-enhanced MR imaging can provide appropriate 22 was obtained if the patient had symptoms or abnormal examination on September 27, 2021 by guest. Protected copyright. information for the assessment of myometrial invasion. Endome- results. Surgery was recommended after childbearing or when the trial cancer was staged with the International Federation of Gyne- 23 patient did not want to get pregnant anymore. Patients with persis- cology and Obstetrics (FIGO) system. Hormonal therapy was used tent disease for more than 12 months, progressive disease, or for those who wanted to preserve fertility and had presumed stage recurrent disease were strongly recommended to undergo surgery. IA, grade 1 or 2 endometrioid endometrial cancer. Several studies are proposed to treat stage IA, grade 2 endometrioid endometrial cancer for fertility-sparing.24–27 Patients with non-endometrioid Statistical Analysis histology or presumed stage IA, grade 3 or over stage IB endome- The primary outcome was to compare the pregnant and non-preg- trial cancer with any grade were excluded. nant groups in terms of all possible factors that might be associ- ated with pregnancy success such as age, tumor grade, treatment Management and Follow-up duration, time of remission, progestin dose difference, number of Hormonal treatment was started with oral medroxyprogesterone D&Cs, and endometrial thickness on transvaginal ultrasound. The acetate 500 mg once daily. In addition, levonorgestrel-release secondary outcome was to compare the pregnancy and oncologic intra-uterine devices were inserted at the beginning of treatment. outcomes between the two groups. Depending on the normality of Follow-up for D&C was done every 3 months with transvaginal the distribution of continuous variables, the Student’s t-test or the ultrasound and CA-125 tests.28 29 Levonorgestrel-release intra- Mann-Whitney U test was used to compare the mean values of uterine devices were changed every 3 months after D&Cs. Complete the two groups. The χ2 test was used to compare the frequency remission was confirmed if carcinoma was absent on pathology. distribution of categorical variables. We performed univariate 78 Chae SH, et al. Int J Gynecol Cancer 2019;29:77–85. doi:10.1136/ijgc-2018-000036
Load more

Recommended publications
  • Ovarian Cancer and Cervical Cancer
    What Every Woman Should Know About Gynecologic Cancer R. Kevin Reynolds, MD The George W. Morley Professor & Chief, Division of Gyn Oncology University of Michigan Ann Arbor, MI What is gynecologic cancer? Cancer is a disease where cells grow and spread without control. Gynecologic cancers begin in the female reproductive organs. The most common gynecologic cancers are endometrial cancer, ovarian cancer and cervical cancer. Less common gynecologic cancers involve vulva, Fallopian tube, uterine wall (sarcoma), vagina, and placenta (pregnancy tissue: molar pregnancy). Ovary Uterus Endometrium Cervix Vagina Vulva What causes endometrial cancer? Endometrial cancer is the most common gynecologic cancer: one out of every 40 women will develop endometrial cancer. It is caused by too much estrogen, a hormone normally present in women. The most common cause of the excess estrogen is being overweight: fat cells actually produce estrogen. Another cause of excess estrogen is medication such as tamoxifen (often prescribed for breast cancer treatment) or some forms of prescribed estrogen hormone therapy (unopposed estrogen). How is endometrial cancer detected? Almost all endometrial cancer is detected when a woman notices vaginal bleeding after her menopause or irregular bleeding before her menopause. If bleeding occurs, a woman should contact her doctor so that appropriate testing can be performed. This usually includes an endometrial biopsy, a brief, slightly crampy test, performed in the office. Fortunately, most endometrial cancers are detected before spread to other parts of the body occurs Is endometrial cancer treatable? Yes! Most women with endometrial cancer will undergo surgery including hysterectomy (removal of the uterus) in addition to removal of ovaries and lymph nodes.
    [Show full text]
  • Sexual Dysfunction in Gynecologic Cancer Patients
    WCRJ 2017; 4 (1): e835 SEXUAL DYSFUNCTION IN GYNECOLOGIC CANCER PATIENTS L. DEL PUP Division of Gynecological Oncology, CRO Aviano, National Cancer Institute, Aviano (PN), Italy. Abstract – Objective: Sexual dysfunction is prevalent among gynecologic cancer survivors and strongly impacts on the quality of life (QoL), but the subject is poorly diagnosed and treated. Materials and Methods: A comprehensive literature search of English language studies on sex- ual dysfunctions due to gynecologic cancer treatment has been conducted on MEDLINE databases. Results: Surgery, radiation, and chemotherapy can cause any kind of sexual dysfunction with different mechanisms: psychological and relational, hormonal and pharmacological, neurological and vascular, side effects of chemo and radiation therapies, and direct effects of surgery on sexually involved pelvic organs. Many patients expect their healthcare providers to address sexual health concerns, but most have never discussed sex-related issues with their physician, or they do not re- ceive a proper treatment or referral. This can have medical legal consequences, because it must be discussed and documented before starting treatment. Conclusions: Oncology providers can make a significant impact on the QoL of gynecologic cancer sur- vivors by informing patients and by asking them for sexual health concerns. Counseling is per se beneficial, as it improves QoL. Furthermore, it permits a proper referral and resolution of most symptoms. KEYWORDS: Gynecologic cancer, Sexual dysfunction, Vulvar cancer, Vaginal cancer, Cervical cancer, Endometrial cancer, Ovarian cancer, Ospemifene. INTRODUCTION ly ask about sexual issues, but 64% state that phy- sicians never initiates the conversation during their The proportion of people living with and surviv- care3. ing gynecologic cancer is growing.
    [Show full text]
  • Endometrial Cancer As a Metabolic Disease with Dysregulated PI3K Signaling: Shedding Light on Novel Therapeutic Strategies
    International Journal of Molecular Sciences Review Endometrial Cancer as a Metabolic Disease with Dysregulated PI3K Signaling: Shedding Light on Novel Therapeutic Strategies Satoru Kyo * and Kentaro Nakayama Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan; [email protected] * Correspondence: [email protected]; Tel.: +81-(0)853-20-2268; Fax: +81-(0)853-20-2264 Received: 3 July 2020; Accepted: 21 August 2020; Published: 23 August 2020 Abstract: Endometrial cancer (EC) is one of the most common malignancies of the female reproductive organs. The most characteristic feature of EC is the frequent association with metabolic disorders. However, the components of these disorders that are involved in carcinogenesis remain unclear. Accumulating epidemiological studies have clearly revealed that hyperinsulinemia, which accompanies these disorders, plays central roles in the development of EC via the insulin-phosphoinositide 3 kinase (PI3K) signaling pathway as a metabolic driver. Recent comprehensive genomic analyses showed that over 90% of ECs have genomic alterations in this pathway, resulting in enhanced insulin signaling and production of optimal tumor microenvironments (TMEs). Targeting PI3K signaling is therefore an attractive treatment strategy. Several clinical trials for recurrent or advanced ECs have been attempted using PI3K-serine/threonine kinase (AKT) inhibitors. However, these agents exhibited far lower efficacy than expected, possibly due to activation of alternative pathways that compensate for the PIK3-AKT pathway and allow tumor growth, or due to adaptive mechanisms including the insulin feedback pathway that limits the efficacy of agents. Overcoming these responses with careful management of insulin levels is key to successful treatment.
    [Show full text]
  • Papillary Carcinoma in Mature Teratoma of Struma Ovarii
    Srbovan, D et al 2015 Papillary Carcinoma in Mature Teratoma of Struma Ovarii. Journal of the Belgian Society of Radiology, 99(1), pp. 76–78, DOI: http://dx.doi.org/10.5334/jbr-btr.855 CASE REPORT Papillary Carcinoma in Mature Teratoma of Struma Ovarii D. Srbovan*, J. Mihailović*, K. Nikoletić*, E. Matovina† and N. Šolajić† A 62-year-old woman had the incidental finding of malignant struma ovarii following surgery for primary endometrial carcinoma. The patient had vaginal bleeding for one year. After gynecological examination, she was referred for fractional curettage which revealed endometrial cancer. The patient underwent total hysterectomy and bilateral adnexectomy. Histological findings of uterus confirm the presence of endo- metrial cancer. The left ovary showed the presence of mature teratoma with dominant thyroid tissue and focus of papillary carcinoma. Postoperatively she underwent radiation therapy and 3 months later total thyroidectomy. The stimulated thyroglobulin level was detectable. She was referred for radioiodine abla- tion with a dose of 3,7GBq 131-J. Post therapy scintigraphy shows pathological uptake of 131-J only in the neck. The patient continued treatment of endometrial cancer (external beam therapy). She is cur- rently on suppressive hormone L-thyroxin therapy. Two months later hormonal status, thyroglobulin and antithyroglobulin antibodies showed optimal range. Keyword: Teratoma Struma ovarii is a rare form of germ cell derived ovarian Case report tumor defined by the presence of thyroid tissue compris- A 62-year-old woman was admitted to the Department of ing more than 50% of the overall mass [1]. Struma ovarii Gynecology at the Institute of Oncology Vojvodina with was first described in 1899 which literally means “goiter of the complaint of vaginal bleeding for one year.
    [Show full text]
  • July 2013 Newsletter
    JULY 2013 NEWSLETTER BLAC K WOMEN'S HEALTH STUDY IN SIDE: Working together • The BWHS Examines Stress and Illness to improve the health of • Health Recommendations black women • New BWHS Cancer Research www.bu.edu/bwhs STUDYING STRESS IN THE BWHS I HIS NEWSLETTER focuses on BWHS studies of "stressors"-experiences that may evoke a stress response in the body. This "fight or flight response" has probably been Tpresent for thousands of years; for early humans, it was critical to survival. In the face of danger, the body produces chemicals that increase heart beat and blood flow, preparing the person to fight or to run away. This kind of response to short-term stress makes sense, even now. When we shout, "Don't touch!" to a toddler who is near a hot stove, the child may become stressed for a few moments, but learns not to touch the stove. However, stresses that are present IN EMERGENCY BREAK GLASS all or most of the time-chronic stresses-can have undesirable effects on physical and mental health. The I FIGHT I IFLIGHT I BWHS is making important contributions by studying stressors in relation to a range of diseases that affect black women. This research will help explain how and why illness occurs and, we hope, provide strong evi­ ct~ dence for public policies, programs, and laws that can help reduce stress in people's lives. THE 2013 HEALTH INFORMATION UPDATE Once again, it's time to update your health information with the BWHS. You may have received an email inviting you to fill out the 2013 health survey online, or a paper survey in the mail.
    [Show full text]
  • Postoperative Surgical Complications of Lymphadenohysterocolpectomy
    Journal of Medicine and Life Vol. 7, Issue 1, January-March 2014, pp.60-66 Postoperative surgical complications of lymphadenohysterocolpectomy Marin F., Pleşca M., Bordea C.I., Voinea S.C., Burlănescu I., Ichim E., Jianu C.G., Nicolăescu R.R., Teodosie M.P., Maher K., Blidaru A. Department of Surgical Oncology II, " Prof. Dr. Al Trestioreanu " Institute of Oncology, Bucharest Correspondence to: Dr. Bordea Cristian Contact adress: 252 Fundeni St., District 2, Bucharest Phone: 021 227 11 15, E-mail:[email protected] Received: July 19th, 2013 – Accepted: October 22 nd, 2013 Abstract Rationale The current standard surgical treatment for the cervix and uterine cancer is the radical hysterectomy (lymphadenohysterocolpectomy). This has the risk of intraoperative accidents and postoperative associated morbidity. Objective The purpose of this article is the evaluation and quantification of the associated complications in comparison to the postoperative morbidity which resulted after different types of radical hysterectomy. Methods and results Patients were divided according to the type of surgery performed as follows: for cervical cancer – group A- 37 classic radical hysterectomies Class III Piver - Rutledge -Smith ( PRS ), group B -208 modified radical hysterectomies Class II PRS and for uterine cancer- group C -79 extended hysterectomies with pelvic lymphadenectomy from which 17 patients with paraaortic lymphnode biopsy . All patients performed preoperative radiotherapy and 88 of them associated radiosensitization. Discussion Early complications
    [Show full text]
  • Radical Abdominal Hysterectomy
    GYNECOLOGIC ONCOLOGY 00394109/01 $15.00 + .OO RADICAL ABDOMINAL HYSTERECTOMY Nadeem R. Abu-Rustum, MD, and William J. Hoskins, MD Radical abdominal hysterectomy was developed in the late nineteenth cen- tury for the treatment of cancer of the cervix uteri and upper vagina. The procedure was originally described in 1895 by Clark and Reis,3°,39but Wertheim is credited for the development and improvement of the basic technique of radical hysterectomy. Wertheim reported extensively on his early results with this procedure and was a pioneer in describing approaches to reducing problems with hemorrhage, urinary tract injury, fistula formation, and sepsis3 Over the past century, the procedure underwent several refinements in indications, patient selection, and surgical technique. Moreover, the advancements in anesthesiology, antibiotics, and preoperative and postoperative medical care have resulted in a significant reduction in morbidity and mortality from this procedure. Several competitors to radical abdominal hysterectomy have emerged over the years. Radiotherapy, discovered around the time that radical hysterectomy was being developed, continues to be used for the treatment of patients with advanced-stage (International Federation of Gynecologic Oncology [FIGO] stages IIB-IV) and selected patients with early stage cervical cancer. Further- more, radical vaginal hysterectomy (Schauta-Amreich) has seen a recent revival since its early description, mainly because of the advancements in laparoscopic pelvic and paraaortic lymphadenectomy, which would accompany the vaginal resection of malignancy. In addition, laparoscopic radical hysterectomy and fertility-sparing radical transvaginal trachelectomy (i.e., removing the cervix and preserving the corpus) with laparoscopic pelvic lymphadenectomy are among the newest techniques to compete with the classic radical abdominal hysterec- tomy for the treatment of early cervical cancer.
    [Show full text]
  • Uterine (Womb) Cancer
    UTERINE (WOMB) CANCER The Facts About 460 women are diagnosed with uterine (womb) cancer every year in Ireland. It is now the most common type of gynaecological cancer in the developed world. The majority of uterine cancers arise from the lining of the uterus/womb known as the endometrium. The term endometrial cancer is often used in these cases. Fallopian Tube Symptoms The most common symptom of uterine cancer is abnormal bleeding from the vagina, especially in women who have stopped having periods (post-menopausal women). Abnormal bleeding can be: • vaginal bleeding after the menopause • bleeding that is unusually heavy or happens between periods • vaginal discharge – this can range from pink and watery to dark and foul smelling About 9 out of 10 womb cancers (90%) are picked up because of post-menopausal or irregular vaginal bleeding. This is why womb cancer is often diagnosed early. UTERINE (WOMB) CANCER Risk Factors Certain factors appear to increase your risk of developing womb cancer, including: • Age: It is more common in women after the menopause between the ages of 50 and 64. However, it can still occur in women prior to the menopause. • Being Overweight: If you are overweight, your risk of womb cancer is increased. • Hormone replacement therapy (HRT): If you are taking oestrogen-only HRT for a long time after the menopause, your risk of womb cancer is increased. • Family history: In a small number of families, a faulty gene can be inherited and cause a condition called Lynch Syndrome (hereditary nonpolyposis colorectal cancer or HNPCC). This means a higher risk of developing certain cancers which include uterine, bowel and ovarian cancer.
    [Show full text]
  • TIP 51 Substance Abuse Treatment Addressing the Specific Needs Of
    Substance Abuse Treatment: Addressing the Specific Needs of Women A Treatment Improvement Protocol TIP 51 Substance Abuse Treatment: Addressing the Specific Needs of Women A Treatment Improvement Protocol TIP 51 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Substance Abuse and Mental Health Services Administration 1 Choke Cherry Road Rockville, MD 20857 Acknowledgments Recommended Citation This publication was prepared under contract Substance Abuse and Mental Health Services numbers 270-99-7072 and 270-04-7049 by the Administration. Substance Abuse Treatment: Knowledge Application Program (KAP), a Joint Addressing the Specific Needs of Women. Treat­ Venture of The CDM Group, Inc., and JBS ment Improvement Protocol (TIP) Series, No. International, Inc., for the Substance Abuse 51. HHS Publication No. (SMA) 13-4426. Rock­ and Mental Health Services Administration ville, MD: Substance Abuse and Mental Health (SAMHSA), U.S. Department of Health and Hu­ Services Administration, 2009. man Services (HHS). Andrea Kopstein, Ph.D., M.P.H., Karl D. White, Ed.D., and Christina Currier served as the Contracting Officer’s Rep­ Originating Office resentatives. Quality Improvement and Workforce Develop­ ment Branch, Division of Services Improve­ Disclaimer ment, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services The views, opinions, and content of this publi­ Administration, 1 Choke Cherry Road, Rock­ cation are those of the author and do not neces­ ville, MD 20857. sarily reflect the views, opinions, or policies of SAMHSA or HHS. HHS Publication No. (SMA) 13-4426 Public Domain Notice First Printed 2009 All material appearing in this report is in the Revised 2010, 2012, and 2013 public domain and may be reproduced or copied without permission from SAMHSA.
    [Show full text]
  • NCCN Guidelines for Patients Uterine Cancer
    NCCN GUIDELINES FOR PATIENTS® 2021 Uterine Cancer Endometrial Carcinoma Uterine Sarcoma NATIONAL COMPREHENSIVE CANCER NETWORK Presented with support from: FOUNDATION Guiding Treatment. Changing Lives. Available online at NCCN.org/patients Ü Uterine Cancer It's easy to get lost in the cancer world Let NCCN Guidelines for Patients® be your guide 9 Step-by-step guides to the cancer care options likely to have the best results 9 Based on treatment guidelines used by health care providers worldwide 9 Designed to help you discuss cancer treatment with your doctors NCCN Guidelines for Patients® Uterine Cancer, 2021 1 UterineAbout Cancer National Comprehensive Cancer Network® NCCN Guidelines for Patients® are developed by the National Comprehensive Cancer Network® (NCCN®) NCCN Clinical Practice NCCN Guidelines NCCN Guidelines in Oncology for Patients (NCCN Guidelines®) 9 An alliance of leading 9 Developed by doctors from 9 Present information from the cancer centers across the NCCN cancer centers using NCCN Guidelines in an easy- United States devoted to the latest research and years to-learn format patient care, research, and of experience 9 For people with cancer and education 9 For providers of cancer care those who support them all over the world Cancer centers 9 Explain the cancer care that are part of NCCN: 9 Expert recommendations for options likely to have the NCCN.org/cancercenters cancer screening, diagnosis, best results and treatment Free online at Free online at NCCN.org/patientguidelines NCCN.org/guidelines These NCCN Guidelines for Patients are based on the NCCN Guidelines® for Uterine Neoplasms, Version 3.2021 — June 3, 2021. © 2021 National Comprehensive Cancer Network, Inc.
    [Show full text]
  • Ovary and Uterus Related Adverse Events Associated with Statin
    www.nature.com/scientificreports OPEN Ovary and uterus related adverse events associated with statin use: an analysis of the FDA Adverse Event Reporting System Xue‑feng Jiao1,2,3,4,7, Hai‑long Li1,2,3,7, Xue‑yan Jiao5, Yuan‑chao Guo1,2,3, Chuan Zhang1,2,3, Chun‑song Yang1,2,3, Li‑nan Zeng1,2,3, Zhen‑yan Bo1,2,3, Zhe Chen1,2,3, Hai‑bo Song6* & Ling‑li Zhang1,2,3* Experimental studies have demonstrated statin‑induced toxicity for ovary and uterus. However, the safety of statins on the functions of ovary and uterus in real‑world clinical settings remains unknown. The aim of this study was to identify ovary and uterus related adverse events (AEs) associated with statin use by analyzing data from FDA Adverse Event Reporting System (FAERS). We used OpenVigil 2.1 to query FAERS database. Ovary and uterus related AEs were defned by 383 Preferred Terms, which could be classifed into ten aspects. Disproportionality analysis was performed to assess the association between AEs and statin use. Our results suggest that statin use may be associated with a series of ovary and uterus related AEs. These AEs are involved in ovarian cysts and neoplasms, uterine neoplasms, cervix neoplasms, uterine disorders (excl neoplasms), cervix disorders (excl neoplasms), endocrine disorders of gonadal function, menstrual cycle and uterine bleeding disorders, menopause related conditions, and sexual function disorders. Moreover, there are variabilities in the types and signal strengths of ovary and uterus related AEs across individual statins. According to our fndings, the potential ovary and uterus related AEs of statins should attract enough attention and be closely monitored in future clinical practice.
    [Show full text]
  • Survival Outcome of Women with Synchronous Cancers of Endometrium and Ovary: a 10 Year Retrospective Cohort Study
    Original Article J Gynecol Oncol Vol. 22, No. 4:239-243 pISSN 2005-0380 http://dx.doi.org/10.3802/jgo.2011.22.4.239 eISSN 2005-0399 Survival outcome of women with synchronous cancers of endometrium and ovary: a 10 year retrospective cohort study Yong Kuei Lim1, Rama Padma1, Lilian Foo2, Yin Nin Chia1, Philip Yam1, John Chia3, HS Khoo-Tan3, Swee Peng Yap3, Richard Yeo3 1Department of Gynaecological Oncology, KK Women’s & Children’s Hospital, 2Duke-NUS Graduate Medical School, 3Department of Medical Oncology, National Cancer Centre, Singapore Objective: Synchronous occurrence of endometrial and ovarian tumors is uncommon, and they affect less than 10% of women with endometrial or ovarian cancers. The aim of this study is to describe the epidemiological and clinical factors; and survival outcomes of women with these cancers. Methods: This is a retrospective cohort study in a large tertiary institution in Singapore. The sample consists of women with endometrial and epithelial ovarian cancers followed up over a period of 10 years from 2000 to 2009. The epidemiological and clinical factors include age at diagnosis, histology types, grade and stage of disease. Results: A total of 75 patients with synchronous ovarian and endometrial cancers were identified. However, only 46 patients met the inclusion criteria. The median follow-up was 74 months. The incidence rate for synchronous cancer is 8.7% of all epithelial ovarian cancers and 4.9% of all endometrial cancers diagnosed over this time frame. Mean age at diagnosis was 47.3 years old. The most common presenting symptom was abnormal uterine bleeding (36.9%) and 73.9% had endometrioid histology for both endometrial and ovarian cancers.
    [Show full text]