Adenocarcinoma of the endometrium and abnormal ovarian function in young women

Progesterone receptor modulators and the endometrium: changes and consequences

Progesterone receptor modulators (PRMs) have been used for contraceptive research, as well as for treatment of fibroids, endometriosis and heavy or irregular menstrual bleeding. Long-term treatment with these compounds results in changes to the endometrium resulting in potential confusion in trying to characterize endometrial biopsies. A meeting was held to discuss the properties of PRMs, the effects of perturbed hormonal control of the endometrium and the need for further understanding of the biology of progesterone receptor action to facilitate the development of new PRMs. A panel of pathologists was convened to evaluate endometrial changes associated with a minimum of three months of chronic treatment with PRMs. Four different agents were used in the treatment regimens but the pathologists were blinded to treatment regimen or agent. The panel agreed that the endometrial biopsies did not fit into a classification of either proliferative or secretory endometrium but exhibited an unusual architecture that could be characterized as glandular dilatation. There was little evidence of mitosis, consistent with a proposed anti-proliferative effect of PRMs. The panel concluded that the biopsies did not reveal evidence of safety concern and that pathologists and investigators familiar with endometrial effects of chronic PRM exposure should consider working with pharmaceutical companies and regulatory agencies to develop standard descriptions of PRM-associated endometrial changes as well as the types of histologic changes that would signal a need for intervention.

Plasma Steroid Transport in Subjects with Tumors of Hormonal Target Organs: A Review

Tumors derived from a hormonal target organ are assumed to be stimulated by the same hormone that stimulates the normal target tissue. In spite of attempts to acquire direct indications of a correlation between hormones and cancer, none have been definitive because studies of total and free hormone levels have given contradictory results. For this reason, attention has shifted to the study of plasma binding and transport of hormones, that is, of the proteins responsible for modulation of the hormone effect and thus of hormone bioavailability. The data reviewed indicate that in-depth study of the transport and binding system of sex steroids would give new information about the endocrine characteristics of cancer patients.

Endometrial carcinoma; ovarian dysfunction--a risk factor in young women

From a referral area comprising one-fifth of the Swedish female population we investigated possible risk factors for endometrial cancer (EC) in different age groups. Seventy-seven women aged 31-45 with EC were collected retrospectively, and 99 women aged 46-65 were consecutively collected. Both groups were compared to referents randomly selected from a population based study from the city of Göteborg. The referents consisted of 1746 women aged 39-65 years. All cases were studied by hospital record and 82% of the women aged 31-45 years and 85% of those aged 46-65 years were studied by an extensive questionnaire. Among the referents 1409 (81%) were investigated by the above-mentioned questionnaire. Hirsutism, increased body mass index (BMI) and hypertension were significantly more common in both EC groups compared to referents. Nulliparity and infertility were significantly more common in the young EC group. Referents used combined oral contraceptives significantly more often than women developing EC. There was, however, no difference between the groups with respect to the duration of medication with combined oral contraceptives. There was a significant negative correlation between cigarette smoking and the development of EC. These findings indicate that untreated ovarian dysfunction like that present in polycystic ovarian disease (PCO) with unopposed estrogen action on the endometrium is associated with EC in younger women, and that smoking may protect against EC by an 'anti-estrogenic' effect.

Reduced incidence of rabbit endometrial neoplasia with levonorgestrel implant

To test the hypothesis that progestogens protect against the development of endometrial neoplasia, we placed polydimethylsiloxane implants (levonorgestrel or inert) into the right uterine horn at random in 114 old female rabbits. Cross-sectional uterine biopsy specimens were taken from both horns at the time of implantation and at 6, 12, and 24 months thereafter. Twenty-nine levonorgestrel-treated and 33 controls survived to the completion of the study. The incidence of endometrial neoplasia of 17.2% in the group treated with levonorgestrel was significantly less (p less than 0.05) than the 42.4% incidence observed in the control does. Before the completion of the study, one levonorgestrel-treated doe died and was found to have an endometrial tumor. When the findings of this doe are included in the report, the statistical significance is marginally lost. No endometrial neoplasia was found in the eight does with serum levonorgestrel concentrations greater than 0.12 ng/ml. Only one of the five tumors in the levonorgestrel-treated group occurred in the horn containing the levonorgestrel implant, which suggests that a dose effect is likely. Treatment with levonorgestrel decreases the incidence of endometrial neoplasia in rabbits. This finding gives further credence to the use of progestogen supplementation in women at risk for developing endometrial neoplasia.

Origin of carcinoma in secretory endometrium--a study using a whole-organ sectioning technique

Uteri from four patients with endometrial adenocarcinoma and concomitant "functioning" endometrium were examined by a whole-organ sectioning technique. All showed one or several "progesterone-refractory" mucosal areas or polyps, mainly in the tubal recesses. In one patient the adenocarcinoma obviously originated in a fundal polyp, and in the others the tumors could have arisen in mucosal areas not adequately responding to progesterone. These findings do not in fact contradict the "unopposed estrogen" theory of the genesis of endometrial carcinoma.

Plasma androstenedione and oestrone levels before and after the menopause. I. Glandular hyperplasia and adenocarcinoma of the endometrium

Plasma androstenedione (A) levels and plasma oestrone (E1) levels were measured by radioimmunoassay in a total of 135 healthy women (the control group), around the menopause. Both A and E1 plasma levels were found to drop significantly in the post-menopausal women (P less than 0.001). The mean plasma levels of A and E1 found in these healthy women were compared with the same plasma levels found in a total of 96 hospitalized women who were found to have various gynaecological disorders. Out of the total 96 patients, 29 were post-menopausal and had adenocarcinoma of the endometrium. The mean plasma levels of A and E1 were not significantly different in comparison with the norm. The mean body weight of the tumour patients was slightly higher than the mean body weight of the healthy women. There were 25 other patients, around the menopause, who had glandular hyperplasia of the endometrium. The mean plasma levels of androstenedione found in these women were significantly higher than the mean levels found in the healthy group of women; both groups were similar in body weight. The oestrone levels found in these patients were within the normal range. The remaining 42 patients, around the menopause, were affected with dysfunctional uterine bleeding, without endometrial hyperplasia. The plasma androstenedione levels were within the normal range. Oestrone plasma levels were not measured in this group of women. This study investigates the possible differences found in the endocrine plasma levels of women with glandular hyperplasia and adenocarcinoma of the endometrium.

Interaction of drugs, hormones, and nutrition in the causes of cancer

Hormones may act as promoters in the carcinogenic process, and occasionally their metabolites may act as antihormones or have new physiologic effects. Drugs can interact with the endocrine system in many ways. They can promote secretion of a hormone, alter its rate of removal from plasma, change plasma protein-binding characteristics, or modify routes of metabolism. Estrogens have a preparative effect on the uterine endometrium. There are biologic, clinical and epidemiologic reasons for believing that estrogen administration to postmenopausal women increases the risk for endometrial cancer. Although there are similar biologic reasons to associate prolonged estrogenic stimulation with breast cancerr, evidence for such an association is weak. Oral contraceptive use has been associated with a variety of hepatocellular tumors. Although estrogens, per se, can effect several hepatic functions, it seems likely that the 17 alpha-alkyl and 17 alpha-ethinyl functions of the progestins and estrogens are involved in this process. The role of estrogen use during pregnancy in the causation of vaginal cancer in female offspring and the role of androgens in prostate cancer have been discussed.