Estrogen replacement therapy following oophorectomy in women with a family history of ovarian cancer

Mucins in ovarian cancer diagnosis and therapy

Ovarian cancer is the most lethal gynecologic malignancy and the five-year survival rate is only 35% after diagnosis. Epithelial ovarian cancer is a highly metastatic disease characterized by widespread peritoneal dissemination and ascites. The death incidences from ovarian cancer could be significantly lowered by developing new methods for the early diagnosis and treatment of this fatal disease. Several potential markers have been identified recently. However, mucins are the most promising markers for ovarian cancer diagnosis. Mucins are large extracellular, heavily glycosylated proteins and their aberrant expression has been implicated in the pathogenesis of a variety of cancers, including ovarian cancer. This review will summarize known facts about the pathological and molecular characteristics of ovarian cancer, the current status of ovarian cancer markers, as well as general information about mucins, the putative role of mucins in the progression of ovarian cancer and their potential use for the early diagnosis and treatment of this disease.

Hormone replacement after gynaecological cancer

Treatment of gynaecological cancer frequently results in the loss of ovarian function and menopausal symptoms. Symptoms of iatrogenic menopause are usually significantly more intense than those of natural menopause due to sudden onset of symptoms, younger age and its effects on common physical and psychological problems of cancer therapy like body image concerns and sexual dysfunction. The most effective treatment for menopausal symptoms is hormone replacement therapy (HRT). However, it is very controversial if HRT is safe in patients after a gynaecological malignancy. The main concerns are the potential stimulation of residual cancer and the induction of new hormone-dependent disease. However, the majority of the most common gynaecological malignancies like squamous cell carcinomas of the cervix, serous papillary epithelial ovarian carcinomas and squamous cell carcinomas of the vulva are not oestrogen dependent. Furthermore, current scientific evidence does not show HRT to adversely affect the outcome in patients after treatment for hormone sensitive cancers like early stage endometrioid adenocarcinomas of the endometrium. There are only a small number of gynaecological malignancies like low grade endometrial stromal sarcomas in which HRT is an absolute contraindication. Therefore, as maintaining quality of life and minimising the physical and psychological impact of treatment side effects is one of the most important factors in cancer care, it is imperative to give patients unbiased information about their individual cancer which in most cases will allow them to use HRT without any detrimental effect on their survival.

Familial ovarian cancer and early ovarian cancer: biologic, pathologic, and clinical features

Women with ovarian cancer have poor overall survival rates, largely because the disease is so often diagnosed at an advanced, less curable stage. Because women with early ovarian cancer experience good survival rates, there is great interest in the study and detection of early disease. Familial ovarian cancer has been relevant to the study of early ovarian cancer in two different ways. First, women from ovarian cancer families often undergo prophylactic oophorectomy to prevent development of this disease. These ovaries have been studied for pathologic or molecular features that might represent early preinvasive disease. Second, screening tests to detect presymptomatic ovarian cancer have selectively targeted this population because of the increased positive predictive value of these tests in this population. A review of the clinical, pathologic, epidemiologic, and molecular biologic aspects of familial ovarian cancer provides a background to facilitate understanding these issues.

A qualitative study of the information needs of high-risk women undergoing prophylactic oophorectomy

This qualitative study sought to determine the information needs of high-risk pre-menopausal women who had undergone prophylactic bilateral oophorectomy to manage their inherited risk of ovarian cancer. In-depth interviews were carried out with 23 high-risk women following surgery. Although the benefit of risk reduction was perceived as out weighing the costs of surgery, many women reported that they would have liked more information about the physical and emotional after-effects of oophorectomy prior to and following surgery. The analysis identified five different types of information needed by women making surgical decisions, comprising information about ovarian function and the menopause, hormone replacement therapy (HRT), surgical procedures, convalescence and the risk of inheriting a genetic mutation and developing cancer. It is suggested that, in addition to genetic counselling for hereditary ovarian cancer, women should receive information about both the costs and benefits of prophylactic oophorectomy, and should have access to gynaecology nurse specialists both before and after surgery.

Estrogen replacement therapy for ovarian carcinoma survivors: A randomized controlled trial

BACKGROUND

Surgery for premenopausal and perimenopausal patients with epithelial ovarian carcinoma may often result in significant menopausal symptoms. Physicians may well be reluctant to prescribe, and patients loathe to take, postoperative estrogen replacement therapy because they fear that supplementation may lead to ovarian carcinoma relapse. This randomized prospective study was undertaken to determine whether postoperative estrogen replacement therapy had a negative influence on the disease free interval and overall survival of ovarian carcinoma survivors.

METHODS

Between January 1987 and June 1994, at the time of a routine consultation held 6-8 weeks postoperatively, 130 patients younger than 59 years with invasive epithelial ovarian carcinoma were randomized to continuous oral conjugated equine estrogen (ERT) or to no supplementation (non-ERT). All patients were followed prospectively for a minimum of 48 months.

RESULTS

Three patients in the ERT group and 2 in the non-ERT group were lost to follow-up, so 59 and 66 were finally analyzed in their respective groups. Nine patients originally randomized to ERT refused or stopped their supplementation, whereas 5 in the non-ERT commenced taking estrogens. A total of 32 recurrences occurred in the ERT group and 41 in the non-ERT group. The median disease free interval was 34 versus 27 months, respectively, whereas overall survival was 44 versus 34 months, respectively, for the two groups. The differences in disease free interval (P = 0.785) and overall survival (P = 0.354) between the two groups were not statistically significant.

CONCLUSIONS

Postoperative estrogen replacement therapy did not have a negative influence on the disease free interval and overall survival of ovarian carcinoma survivors.

Laparoscopic management of women with a family history of ovarian cancer

BACKGROUND AND OBJECTIVE

The safety of laparoscopic surgery in women with a family history of ovarian cancer predicted to have benign disease has not been established. The objective of this study was to evaluate the feasibility and complications of operative laparoscopy and to describe the pathologic findings in this patient population.

METHODS

Sixty-two consecutive women with a family history of ovarian cancer who elected prophylactic oophorectomy or had predicted benign adnexal disease were offered laparoscopic surgery. Patient characteristics, details of laparoscopic surgery, operative and postoperative complications, and histopathologic findings were recorded.

RESULTS

Laparoscopy was converted to laparotomy in 2 patients (3.2%); 1 patient (1.6%) had an operative vascular complication, and 1 patient (1.6%) had postoperative bleeding. Median (range) estimated blood loss, operative time, and hospital stay were 50 ml (50-1,500), 120 min (60-290), and 1 day (0-9), respectively. Histopathologic findings included normal ovaries (n = 20), corpus luteum cyst (n = 16), follicular cyst (n = 8), endometriotic cyst (n = 7), serous cystadenoma (n = 5), epithelial hyperplasia (n = 4), dermoid cyst (n = 1), and fibrothecoma (n = 1).

CONCLUSIONS

Laparoscopic surgery is feasible and safe in women with a family history of ovarian cancer predicted to have benign disease and is associated with low blood loss and short hospital stay. Most ovaries removed are either normal or have benign disease.

Estradiol alters cholecystokinin stimulus-response coupling in rat pancreatic acini

We have previously demonstrated that altered exocrine pancreatic stimulus-secretion coupling is associated with ovariectomy and chronic estradiol administration. To elucidate possible mechanisms underlying those effects we examined the ability of chronic administration of different doses of estradiol to regulate the CCK signal transduction pathway in isolated rat pancreatic acini. Doses of estradiol ranging from 0.5 to 119 micrograms/day were administered to ovariectomized rats for 18 days. Ovariectomy was associated with enhanced CCK-stimulated pancreatic amylase release, whereas estradiol dose dependently decreased the magnitude of CCK-stimulated amylase release. Ovariectomy was also associated with enhanced CCK receptor numbers on acinar cell membranes. Estradiol administration was associated with dose-dependent decreases in CCK receptor numbers. Neither ovariectomy nor estradiol administration affected CCK receptor affinity. Moreover, estradiol administration was associated with increased expression of the alpha-subunit of the heterotrimeric G protein Gq/11 (Galphaq/11). Recent findings (H. Ohnishi, S. A. Ernst, D. I. Yule, C. W. Baker, and J. A. Williams. J. Biol. Chem. 272: 16056-16061, 1997) demonstrate that Galphaq/11 may exert a tonic inhibitory effect on pancreatic enzyme release. In view of these findings, the increased expression of Galphaq/11 induced by estradiol likely contributes to the inhibition of pancreatic enzyme release. We conclude that the effect of estradiol to decrease pancreatic secretion is mediated through regulation of CCK receptor density and Galphaq/11 expression.