Endometrial, other carcinomas

In a case-control study (van Leeuwen et al. 1994) in which 98 cases of invasive endometrial carcinoma were diagnosed at least 3 months after diagnosis of primary breast cancer, it was observed that the use of tamoxifen was associated with a RR of 1.3. The risk appeared to have a tendency to increase during treatment, from 0.6 for less than a year to 3.0 for more than 5 years of treatment. It should be noted that the accumulated dose of tamoxifen was significantly associated with risk of endometrial cancer. However, the average daily dose used (20-40 mg/d) did not seem to influence risk. Other authors have also observed that the increase in risk is only detected when a determined accumulated dose is attained (van Leeuwen et al. 1994 De Muylder et al. 1991). 

The major uses of progestogens are for hormone replacement therapy and for hormonal contraception where they suppress ovulation and make the cervical mucus impenetrable to spermatozoa. Other indications include secondary amenorrhea, dysmenorrhea, infertility and habitual abortion and endometrium suppression in endometriosis. Progestogens are also used for palliation in metastasized endometrial and breast carcinoma. Medrogestone has been used in the treatment of fibroid uterine tumors. 

Carcinoma. Estrogen has been used to treat metastatic breast cancer in men and postmenopausal women. Advanced prostate cancer in men may also respond to estrogen treatment. Progesterone is helpful in treating uterine cancer and several other types of metastases, such as breast, renal, and endometrial carcinoma. 

Medroxyprogesterone Cycrin, Provera, others Secondary amenorrhea, dysfunctional uterine bleeding, breast or endometrial carcinoma... 

Menopause is thus the condition in most urgent need of tissue- or cell-targeted endocrine therapy. In fact, estrogen-like compounds are required for prevention of bone loss and cardiovascular disease. On the other hand, for the breast and endometrium, the ideal approach is a pure antiestrogen that would inhibit the development and growth of breast and endometrial carcinoma. The effects required in the skeletal and cardiovascular systems (estrogenic) are thus the opposite of those required in the breast and endometrium, for which antiestrogenic activity is recommended. 

The consequence of the partial agonistic activity of tamoxifen is that complete blockade of the action of estrogens cannot be achieved with tamoxifen (Wakeling, 1993) or the other compounds demonstrated to exert stimulatory effects, reversible with EM-652 on the proliferation of human breast cancer cells and alkaline phosphatase in human endometrial carcinoma cells. It is thus reasonable to expect that the availability of a pure antiestrogen, in addition to avoiding the risk of inducing endometrial carcinoma, should provide significant benefits over tamoxifen in the treatment of breast cancer. 

Tanioxircn hits seen extensive use in treating primary breast cancers that arc ER dependent, For premenopausal women with metastatic disease, tamoxifen is an alternative and adjuvant with oophorectomy, ovarian irradiation, and mastectomy. Tamoxifen u.se. however, is not problem free. Tamoxifen increases the incidence of endometrial polyps. hyperplasia, and carcinoma and uterine sarcomas. The risk of endometrial cancer resulting from tamoxifen is. however. much lower than the "modest but highly significant reductions in morbidity and mortality of breast cancer." Becau.se of the increased risk of endometrial cancer with tamoxifen therapy, tamoxifen. should be u.sed to prevent breast cancer only in women at high ri.sk. Women without a family history of breast cancer or other risks should not use tamoxifen in this manner. 

Gelmann EP. Tamoxifen for the treatment of malignancies other than breast and endometrial carcinoma. Semin Oncol 1997 24 Sl-65-Sl-70. 

CD 10 is a marker of early lymphoid progenitor and normal germinal center cells. However, in the nonhe-matopoietic arena, it reacts mainly against proteins of the epithelium of the renal proximal tubule. It is considered a sensitive marker for renal cell carcinoma and endometrial stromal sarcomas. CD 10 stains some other... 

OTHER HISTOLOGIC SUBTYPES OF ENDOMETRIAL CARCINOMA AND SECONDARY CARCINOMAS, INCLUDING METASTASES (TABLE 18.3)... 

It is indicated for the palliative treatment of endometrial carcinoma and advanced breast cancer when other methods of medication are not effective. 

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