Is it safe to prescribe hormonal contraception and replacement therapy to patients with premalignant and malignant uterine cervices?

Cervical intraepithelial neoplasia: prognosis by combined LOH analysis of multiple loci

OBJECTIVE

Cervical intraepithelial neoplasias (CIN) show markedly variable clinical behavior. Clinically, it is important to distinguish CIN lesions with different behaviors and identify those likely to persist and progress. The purpose of this study is to explore whether CIN lesions with different clinical behaviors can be stratified by analysis of loss of heterozygosity (LOH) at multiple loci.

METHODS

One hundred sixty-four cases of CIN (54 CIN1, 59 CIN2 and 51 CIN3) were screened for LOH at 12 microsatellite markers including 10 from 3p14, 3p21-22, 6p21 and 11q23. LOH was correlated with clinical follow-up data and high-risk HPV infection.

RESULTS

In a pilot study of 71 cases of CIN, screening of 12 microsatellite markers identified four (D3S1300, D3S1260, D11S35, and D11S528) at which LOH was significantly associated with disease persistence/progression. These four markers were further investigated in a larger cohort, which brought the total number of cases examined to 164. Combined analysis of LOH at the above four loci permitted the identification of 22-47% of CIN lesions depending on the histological grade, which showed disease persistence/progression. LOH at these loci was significantly associated with HPV16 infection. Bioinformatic analysis identified several candidate genes including the fragile histidine triad gene and progesterone receptor gene that may be the target of deletions.

CONCLUSIONS

LOH at D3S1300, D3S1260, D11S35 and D11S528 was significantly associated with cins that showed persistence/progression, and combined LOH analyses at these loci could be used to identify such cases.

Quality of life in long-term survivors of cervical cancer

OBJECTIVE

The aim of this study was to evaluate the quality of life within a sample of cervical cancer survivors.

STUDY DESIGN

In this study, 46 cervical cancer survivors at clinical stage I or II and one survivor at stage 0, were evaluated. Two control groups were selected from an ongoing cohort study, in which 527 women were postmenopausal and 344 women were postmenopausal with HRT. All controls and cancer survivors completed a self-evaluating questionnaire pertaining to personal conditions, medical surveillance, individual well-being and quality of life.

RESULTS

Eighteen cervical cancer survivors were ovaries preserved. A total of 28 survivors, who had an oophorectomy, were compared with the controls. Most of the cancer survivors had a good socio-economic background and an active lifestyle. Forty-two percent were currently under medical surveillance and used medication regularly. The ratio of HRT users was higher in the oophorectomy group (36% in both short- and long-term therapy). With regard to the quality of life, there were no remarkable differences between oophorectomy survivors and controls. Except that the psychological condition in the ovaries preserved group was worse, the rest of the findings concerning the quality of life derived from the ovaries preserved group were rather close to that of the oophorectomy group.

CONCLUSION

The quality of life in long-term cervical cancer survivors is generally satisfactory. The positive results may be due to the higher ratio of HRT use, ovarian preservation, good education, working conditions, as well as an active lifestyle.

[Hormone replacement therapy in menopause and cancers]

The long term outcome analysis of estrogen replacement therapy shows that the carcinologic risk is far more inferior than the osseous and cardiovascular risks of which the prevention is ensured by estrogen. In the same way, the quality of life improvement during the years following menopause is important. For a female population without personal risk of breast cancer, the substitutive hormone therapy offers numerous advantages which have been for a long time refused to women with previously treated breast cancer. Any dogmatic behaviour is presently justified. On the contrary, the hormonal replacement therapy requires beforehand an analysis as exact as possible of the risks of its prescription as of its non-prescription and a responsibility taking shared between the physician and his patient. The progresses of the molecular biology and the expansion of randomized trials will permit with no doubt to recognize more easily for each patient, even the one who would have been previously treated for a breast cancer, the respective impact of carcinologic, cardiovascular and osseous risks.

Prognostic and diagnostic implications of estrogen and progesterone receptor assays in cytology

Scientific evidence suggests that cancer is a consequence of genetic changes that result in uncontrolled cellular growth, tissue invasion, and metastasis. This concept has led to a great deal of excitement in the medical community in the hope that precise identification of genes involved in human cancer could potentially facilitate our understanding of human malignancies. It may also be possible to apply this information directly to different clinical settings. Many technologies are now available which offer opportunities for pathologists to not only expand their diagnostic abilities, but also to assess the prognosis of a given tumor in a specific patient. These include immunocytochemistry, flow cytometry, cell image analysis, and molecular genetic studies. In this review, the role of immunocytochemical hormone receptor assay as an aid in tumor prognosis and in prediction of tumor response to endocrine therapy will be discussed. Emphasis will be placed on the use of hormone receptor assay as an adjunct in diagnostic pathology and in assessment of metastatic tumors of unknown origin. The potential value of assessment of hormone receptors in different cytologic preparations will also be discussed.

Immunohistochemical analysis of estrogen receptors, progesterone receptors, Ki-67 antigen, and human papillomavirus DNA in normal and neoplastic epithelium of the uterine cervix

To investigate the relationship between the sex steroid receptor (estrogen receptor [ER] and progesterone receptor [PR]) status and the cell proliferation kinetics during the menstrual cycle in normal and neoplastic epithelium of the uterine cervix, immunohistochemical localization of ER, PR, and cell proliferation-associated antigen, Ki-67, was investigated in 35 normal cervical specimens, 3 condylomas, 26 cervical intraepithelial neoplasia (CIN) samples, and 22 invasive squamous carcinoma samples. The presence of human papillomavirus (HPV) DNA was also studied. In the normal cervix, basal cells were usually ER positive, PR negative, and Ki-67 negative throughout the menstrual cycle. Parabasal cells were ER positive and PR negative in the follicular phase, but ER negative and PR positive, and Ki-67 positive in the luteal phase, and Ki-67-positive cells increased in number in the luteal phase. In contrast, PR positivity was observed in the cells of condyloma (2 of 2 cases), CIN (19 of 26 cases), and invasive squamous carcinoma (13 of 22 cases) irrespective of the menstrual phase. Moreover, most neoplastic cells containing HPV DNA type 16/18 were ER negative, whereas several lesions containing HPV DNA type 31/33/35 were weakly ER positive. Many Ki-67-labeled cells were observed in the neoplastic lesions. These results suggest that reduced ER expression and increased PR expression are associated with the proliferation of normal cervical squamous epithelium, and this proliferation-related receptor status, which is probably induced by HPV infection, is usually expressed in neoplastic cervical squamous cells.