Tumor size in endometrial cancer

Article Abstract:

For several forms of cancer, adjuvant radiotherapy is used after surgery to eliminate small numbers of cancer cells which may have already seeded local lymph nodes. The risk of cancer spread must always be balanced off against the adverse effects of the radiation itself. In the case of endometrial cancer, which affects the lining of the uterus, early Stage I cancer is very often cured by surgery, and thus adjuvant radiotherapy is often considered unnecessary. However, research now suggests that the need for radiotherapy may vary depending on the size of the tumor itself. In a review of 142 cases of Stage I endometrial cancer, patients with the smallest cancers were found to have the best chances for survival. Only 4 percent of the patients with tumors smaller than two centimeters had metastatic spread of their cancer, and 98 percent of the patients were alive five years after treatment. In contrast, patients with tumors larger than two centimeters had an 84 percent chance of surviving for five years. If only those patients are considered who had cancers filling the uterine cavity, the five-year survival was 64 percent. The "grade" of a tumor refers to its appearance under the microscope; low-grade tumors appear similar to normal cells and are regarded as having less malignant potential than high-grade tumors. In the case of endometrial cancer, grade 3 cancer is regarded as sufficiently high grade to warrant adjuvant irradiation. However, it is often considered that a grade 2 endometrial cancer which has invaded the surrounding uterine muscle less than halfway does not warrant adjuvant radiation. Yet in the present study, patients with such grade 2 cancers with primary tumors larger than two centimeters had cancer spread to the lymph nodes in 18 percent of the cases. The patients with primary tumors smaller than two centimeters did not have cancer spread to the pelvic lymph nodes. The size of the endometrial cancer should therefore be taken into account when decisions are made about the risks and benefits of radiotherapy. The size of an endometrial cancer is easy to measure, and in all cases should be recorded for the purposes of future research. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Endometrial cancer, Tumors

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The role of contraception in the development of postmolar gestational trophoblastic tumor

Article Abstract:

Hydatidiform mole is a degenerative condition of the chorionic villi, which are projections of the fetal membrane into the wall of the uterus. This condition is characterized by the formation of numerous cysts, or sac-like structures, in the chorionic villi, and rapid growth and bleeding of uterus. Patients with hydatidiform mole are treated by removal of the mole. Follow-up includes continuous measurement of levels of human chorionic gonadotropin (hCG) produced by the chorionic villi, which should diminish with recovery. However, removal of hydatidiform mole may be followed by the development of gestational trophoblastic tumor. This is an abnormal growth of the trophoblast, the outer layer of the developing embryo, which makes contact with the uterus. Patients should avoid becoming pregnant for at least a year following the removal of a hydatidiform mole. Hence, any rise in hCG levels will most likely be due to the development of gestational trophoblastic tumor rather than pregnancy in patients using contraception. Some studies suggest that the estrogen contained in oral contraceptives may increase the risk of gestational trophoblastic tumor. Hence, the effects of various methods of contraception on the development of gestational trophoblastic tumor, and other risk factors, were assessed in 162 patients with hydatidiform mole and 137 patients with postmolar gestational trophoblastic tumor. The results showed that the risk of developing gestational trophoblastic was lower among oral contraceptive users compared with patients using barrier methods, intrauterine devices, or those who did not use contraception. The risk of gestational trophoblastic tumor was influenced by the following factors: type of contraceptive method; formation of theca-lutein cysts (abnormal sac-like structures in the ovary); Asian heritage of the mother of the patient; decreased duration since last menstrual period; and older age at pregnancy. Thus, oral contraceptive use appears to protect against the development of gestational trophoblastic tumor following removal of hydatidiform mole. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Risk factors, Physiological aspects, Oral contraceptives, Molar pregnancy, Hydatidiform mole

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Prognostic factors in gestational trophoblastic tumors: a proposed new scoring system based on multivariate analysis

Article Abstract:

Gestational trophoblastic disease is a condition in which placental tissue (forming the trophoblast) becomes malignant, invading the uterine wall (the invasive mole) or metastasizing rapidly (choriocarcinoma, another variant). In these disorders, fetal tissue is rarely found. Several scoring systems have been developed to rate the prognosis of patients with gestational trophoblastic disease, which are reviewed. In an attempt to simplify and improve upon current prognostic methods, an analysis was carried out of commonly used factors to determine their relative importance for prognosis. Data from 391 patients with gestational trophoblastic tumors (either invasive mole or choriocarcinoma) treated at one medical institution during a 19-year period were used. Two hundred twenty-three patients had nonmetastatic disease, and the remaining 168 had metastatic tumors, of whom 73 were categorized as high-risk (because of other factors such as the location of metastases). Treatment consisted of single-agent chemotherapy for all patients with nonmetastatic disease and most low-risk metastatic-disease patients; combination chemotherapy was administered to high-risk patients. The treatment protocols changed during the years: all patients treated after 1981 survived. The overall cure rate was 93 percent; all patients with nonmetastatic disease survived, as did 83 percent of those with metastases. The factors most important in predicting a poor outcome for the high-risk patients were a clinical and pathologic diagnosis of chorioangioma, metastases to sites other than the lung or vagina, increasing numbers of metastases, previous unsuccessful chemotherapy, and scores on two other rating scales above certain levels. These factors are discussed. The cure rate for gestational trophoblastic tumors is now greater than 90 percent. The Brewer score, described in the report, and the World Health Organization prognostic scale, are better predictors of outcome in this disorder than other methods reviewed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Pregnancy, Complications of, Pregnancy complications

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