RxPG News : Endometrial

New technique to detect cancer in early stages

Sat, 25 Nov 2006 21:14:28 PST

( from http://www.rxpgnews.com ) Singapore, Nov 25 - A new technique has been developed at Singapore's National University Hospital to detect cancer in its early stages, researchers said Saturday.

The hospital is conducting a trial involving 58 patients, 12 of whom are receiving treatment after the 'optical biopsy' diagnosed them with early-stage cervical cancer.

The technique detects pre-cancers or collections of a few hundred malignant cells among millions of healthy cells.

Pap smears, the usual method used to test for cancer in the cervix, do not detect these pre-cancers, Huang Zhiwei, the project leader, told The Straits Times.

Using light waves near the infrared region of the spectrum, the team reported they were able to accurately detect early tumours deep beneath the tissue surface.

The radiation targets specific proteins and carbohydrates in the cells, Huang said.

Varying combinations of biochemical molecules create a 'fingerprint', helping in determining whether the cell is normal or not, he said.

Conventional methods of optical testing used normal white light or ultraviolet light.

White light allows doctors to view only late-stage tumours that have already caused abnormalities on the tissue surface, Huang said. Ultraviolet light cannot penetrate far into the tissue.

The new technique can eventually be applied to almost any cancer though it would still require more clinical trials, he added.

Adjuvant radiotherapy improves survival in Stage I Endometrial Cancer

Thu, 26 Jan 2006 04:23:37 PST

( from http://www.rxpgnews.com ) Women with stage I endometrial cancer (with grade 1 and grades 3 and 4 disease) who receive radiation therapy in addition to other treatment have improved survival rates, according to a study in the January 25 issue of JAMA.

Endometrial cancer remains the most common gynecological malignancy in the United States, according to background information in the article. However, the optimal supplemental treatment for stage I endometrial cancer remains uncertain.

Christopher M. Lee, M.D., of Huntsman Cancer Hospital and University of Utah Medical Center, Salt Lake City and colleagues conducted a study to quantitatively evaluate the frequency and effect of adjuvant (supplemental) radiation therapy (RT) on overall and relative survival for women with stage I endometrial cancer. The study included 21,249 patients with American Joint Committee on Cancer stage IA-C node-negative endometrial cancer. The researchers used data from the Surveillance, Epidemiology, and End Results Program of the U.S. National Cancer Institute, from January 1, 1988, to December 31, 2001.

Of the 21,249 women, 4,080 received adjuvant RT (19.2 percent) and 17,169 did not receive adjuvant RT (80.8 percent). Adjuvant RT significantly improved overall survival for patients with stage IC/grade 1 and stage IC/grades 3 and 4 disease. Further analysis revealed a statistically detectable association of adjuvant RT with improved relative survival in patients with stage IC/grade 1 (56 percent lower rate of death) and stage IC/grades 3 and 4 (28 percent lower rate of death).

As the largest reported population analysis to our knowledge of adjuvant RT in early stage endometrial adenocarcinoma to date, it is significant that our study reveals a benefit for improved overall and relative survival for adjuvant RT in stage IC/grade 1 and stage IC/grades 3 and 4 disease. This information should be added to previous articles in the literature that confirm beneficial effects of adjuvant RT on both local and distant tumor control for certain patient cohorts, the authors write.

Statistical analysis cannot replace clinical judgment when considering the individual patient, tumor characteristics, and the potential risks and benefits of adjuvant RT. Hopefully, appropriate adjuvant RT will be used to decrease the death rate from this most common of gynecological malignancies. Future work is needed to continue to delineate clinical and biological factors that can guide treatment and account for disparities in outcome between varied subsets of patients, the researchers conclude.

Raloxifene May Protect Against Endometrial Cancer

Tue, 17 May 2005 01:53:38 PST

( from http://www.rxpgnews.com ) A new analysis of patients taking raloxifene and tamoxifen shows that raloxifene may reduce the risk of endometrial cancer (cancer of the uterine lining), and confirms previous studies showing that tamoxifen increases the risk for the disease.

Tamoxifen has been shown to reduce the risk of breast cancer recurrence among women whose cancer is sensitive to estrogen ("hormone receptor positive"), and to reduce the risk of developing breast cancer among women at high risk for the disease. However, this study and others have found that tamoxifen also increases the risk of endometrial cancer. Raloxifene, which belongs to the same class of drugs as tamoxifen called selective estrogen receptor modulators (SERMs) is used to treat osteoporosis and may also reduce the risk of breast cancer. Unlike tamoxifen, however, raloxifene does not stimulate estrogen receptors in the uterine lining.

In a case-control study, researchers compared raloxifene and tamoxifen use between 547 women with endometrial cancer in the Philadelphia area and 1,412 women without cancer who served as controls. Patients were participants in the Women's Insights and Shared Experiences (WISE) study, a project at the University of Pennsylvania School of Medicine that is investigating hormone-related cancers in women. The control group was recruited by random-digit telephone dialing in the Philadelphia area.

Compared to non-users, the risk of endometrial cancer among women taking tamoxifen was 50% higher, while raloxifene users experienced a 50% lower risk. This benefit existed even among women who used raloxifene for less than three years.

"Endometrial cancer is the most common gynecologic cancer, so it's important to start thinking about strategies to reduce risk," said Angela DeMichele, MD, MSCE, Assistant Professor of Medicine at the Abramson Cancer Center and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, and the study's lead investigator. "If raloxifene proves effective at preventing both breast cancer and endometrial cancer, that information could weigh heavily on a woman's decision about which drug to choose."

Another study currently underway called the STAR trial (Study of Tamoxifen and Raloxifene) is comparing raloxifene and tamoxifen for reducing the risk of ever developing breast cancer. Data won't be reported until 2006, but may also reveal important findings regarding endometrial cancer risk.

Cancer Risk Highest in Combined HRT

Fri, 29 Apr 2005 19:57:38 PST

( from http://www.rxpgnews.com ) Some forms of hormone replacement therapy increase the risk of endometrial (womb) cancer, according to results from the Million Women Study, published in the Lancet*(1) today (Friday).

Women taking a relatively new type of HRT, called tibolone*(2), and women taking oestrogen-only HRT are at an increased risk of the disease compared with women who have never taken HRT. Women taking a combination of oestrogen and progesterone have the same or a slightly lower risk of endometrial cancer, compared to women who have never taken HRT.

However, previous research has shown that this combined type of HRT poses a greater breast cancer risk than tibolone or oestrogen-only HRT and, because breast cancer is more common than endometrial cancer, the researchers believe that when considering the overall effect of HRT it is important to look at both breast and endometrial cancer.

When rates for breast and endometrial cancer are taken together, the overall risk is highest in women taking combined HRT.

The study shows that around three out of every 100 women on combined HRT will develop either breast or endometrial cancer over a period of five years. This compares with about two and a half per 100 who take oestrogen-only HRT or tibolone, and around one and a half per 100 who have not taken HRT.

The Million Women Study, funded by Cancer Research UK, the NHS Cancer Screening Programme and the Medical Research Council, includes over a million women aged between 50 and 64 who filled out lifestyle questionnaires, including whether they had taken HRT. Since the late 1990s, when the women were recruited, around 1,300 have developed endometrial cancer and over 10,000 have developed breast cancer.

Lead author Professor Valerie Beral, Director of Cancer Research UK's Epidemiology Unit, explains: "These new results create a dilemma for women who haven't had a hysterectomy and want to use HRT. On one hand, oestrogen-only HRT and tibolone increase the risk of endometrial cancer but, on the other hand, HRT containing both oestrogen and progesterone causes the greatest increase in breast cancer. "Since breast cancer is much more common than endometrial cancer, combined HRT poses the greatest overall cancer risk."

Use of combined and oestrogen-only HRT has fallen over the last three years. Tibolone use has stayed much the same and is now the most common brand of HRT prescribed to women in the study who have not had a hysterectomy*(3).

The study also reinforces the link between obesity*(4) and endometrial cancer; the more overweight a woman is, the greater her risk of endometrial cancer, but this risk varies depending on whether the woman is taking HRT.

Experts believe that oestrogen stimulates growth of the cells in the womb, which can lead to cancer, and women who are obese have higher levels of oestrogen in the blood.

For obese women, oestrogen-only HRT appears to have less impact on the risk of endometrial cancer and this may be because their existing levels of oestrogen are already quite high. Progesterone may go some way towards counteracting the effects of oestrogen, especially in obese women.

Professor John Toy, Cancer Research UK's Medical Director, says: "It's crucial that we understand the effects that drugs can have on our bodies. We already know the impact that HRT has on breast cancer risk and now we understand how it can affect the risk of developing endometrial cancer.

"It's important that women, and the doctors who treat them, are given all the information they need to decide whether to take HRT.

"Our advice remains that women should take HRT for medical need only and the shortest time possible."

Broadening treatment to battle recurrence of endometrial cancer

Mon, 17 Jan 2005 12:38:38 PST

( from http://www.rxpgnews.com ) Mayo Clinic researchers studying endometrial cancer have found that patients at risk for relapse based on identified risk factors had a 46 percent probability of experiencing recurrence within five years despite treatment with state-of-the-art therapy.

The study's findings are important for women deemed at risk because they might need additional treatment, which physicians should consider in their treatment plans for their patients, says Karl Podratz, M.D., Ph.D., the study's lead researcher.

The risk factors the researchers identified were specific characteristics of tissues that had been removed during surgery and were analyzed by microscope. Researchers also said risk factors included whether the tumors were confined to the uterus or if the disease had spread outside the uterus.

In the United States, endometrial cancer is the most common malignancy of the female reproductive tract. Only breast, colon and lung cancers are more prevalent in women. During 2004, it was estimated 40,320 new cases of endometrial cancer would be diagnosed in the United States and 7,090 women would die from the disease.

The study looked at 1,109 patients with endometrial cancer who had surgical treatment at Mayo Clinic in Rochester from 1984 to 1996. Based on data from their medical records, 915 patients with endometrial cancer met the following criteria to be included in the study: treatment included hysterectomy, and no other malignancy was diagnosed within five years before or after the diagnosis of endometrial cancer.

"The 46 percent recurrence rate for the at-risk patients among the expected cases of newly diagnosed endometrial cancer in 2004 is close to the number of deaths the disease is expected to cause in that period," says Dr. Podratz. "We feel that to maximize outcomes, approximately one-third of the patients with endometrial cancer in the United States, or about 14,000 women, would potentially benefit from enrollment in clinical trials addressing the new target-based therapeutic approach."

The new approach for treatment would be based on the inclusion of risk factors identified in previous studies and categorization of patients according to their risks for different patterns of recurrence, such as in the lungs, abdomen or lymph nodes. In doing this, physicians would be able to better predict and focus treatments on anticipated routes of the disease and its relapse.