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TAMOXIFEN IN BREAST CANCER: WHAT EFFECTS DOES TAMOXIFEN HAVE ON THE UTERUS?

admin — Sat, 02 Jul 2011 17:48:08 +0000

Over the years there has been growing evidence that tamoxifen induces tumor growth in the lining of the uterus (or endometrium). In a recent study many of the women who developed irregular vaginal bleeding due to tamoxifen therapy were found also to have small noncancerous growths or polyps of the uterine lining. A number of them went on to develop tumors of the endometrium.Although many physicians consider the incidence of tamoxifen-induced uterine tumors to be small, there is still a significant risk. In one clinical study evaluating 46 nonhysterectomized postmenopausal women receiving tamoxifen for 6 to 36 months, 13 patients developed noncancerous growths or polyps, 8 had thickening of the uterine lining, and 2 developed cancer of the endometrium.The incidence of uterine tumors appears to increase with higher doses of tamoxifen. With the usual dose of 10 mg twice daily, an incidence of 0.17 percent was reported, while patients receiving 20 mg of tamoxifen twice daily had an incidence nearly ten times higher (1.2 percent).Although surgical hysterectomy can be performed once a tumor develops in the uterus, new evidence suggests that the types of tumors that develop while a woman is taking tamoxifen are extremely aggressive. Women who develop uterine cancers induced by tamoxifen therapy may be more likely to die from uterine cancer than those who spontaneously develop this form of cancer.*35\320\2*

DETECTION OF GYNECOLOGICAL CANCER: UTERINE SARCOMAS AND SURVIVAL RATES

admin — Sat, 12 Mar 2011 11:04:22 +0000

Uterine sarcomas are rare malignant tumours of the muscular wall of the womb. As in endometrial cancer, total abdominal hysterectomy and removal of both tubes and ovaries (‘bilateral salpingo-oophorectomy’) is the common treatment. In some circumstances, lymph glands will also be removed to determine whether the cancer has spread.
Since the most common type of sarcoma – the ‘leiomyosarcoma’ – is usually found in association with fibroids, then it is not unusual for the diagnosis of this cancer to occur as an incidental finding following removal of the uterus because of abnormal bleeding due to uterine fibroids.
Under these circumstances, the ovaries are usually left because spread of sarcomas to the ovaries is very rare. In some cases, the ovaries have to be removed such as when an ‘endometrial stromal sarcoma’ is diagnosed since this sort of cancer may be hormone dependent.
There is increasing evidence that the addition of radiation to the pelvis in women with uterine sarcomas reduces the risk of recurrence in the pelvis. Because these cancers are rare, there has been no study comparing women who have been given radiation and those who have not. But studies of women who have been given radiation have shown that compared to other previous patient case histories, there is a reduction in local recurrence.

Survival Rates
The cure of cancer depends on many factors but the most important single factor influencing outcome relates to how far the cancer has spread at the time of diagnosis . . . ‘the stage’ or extent of the spread that the cancer is at.
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HOW IS GYNECOLOGICAL CANCER DETECTED: ENDOMETRIUM

admin — Fri, 25 Feb 2011 11:03:38 +0000

Cancers of the lining of the uterus and of the uterine wall basically cause abnormal bleeding. In women before menopause, this usually is irregular bleeding, but occasionally can cause just heavy periods alone. More than 80% of cases of endometrial cancers occur in older women and postmenopausal bleeding is the most common symptom. Very occasionally a watery discharge can be a symptom and in advanced cases it can spread outside the pelvis to the lungs, liver and bone that can cause cough, jaundice and/or bone pain.

I had had an endometriosis hysterectomy when I was 29, but the endometriosis kept growing on the bowel. When I was 34 I had a piece of the bowel taken but it kept coming back. After four years, they decided to give me radiotherapy because they couldn’t stop it growing. It turned into an endometriotic cancer on the bowel. The radiotherapy burst the bowel. I woke from surgery with five drainage bags on my stomach . . . and now I have none.
Alice
When a woman has irregular bleeding then usually a doctor will examine the cervix to see if it looks normal, do a Pap smear and sample the lining of the womb – an ‘endometrial biopsy’. This is usually done in the gynecologist’s office without anesthetic, but if the woman has never had a baby, then occasionally an anesthetic is required, as the cervix can be very tight.
If the endometrial biopsy fails to show any cancer and the bleeding persists, or if no tissue is obtained, then usually a transvaginal ultrasound is undertaken, where the ultrasound probe is inserted into the vagina. This will show any abnormal areas within the lining of the womb, and in particular in the postmenopausal woman. It will show if the lining of the womb has abnormal thickening (> 5 mm thick). If the lining of the womb has thickened, then a closer examination of the lining of the womb is undertaken. This will be done either under general or local anesthetic by passing a 3-5 mm camera tube through the cervix (a ‘hysteroscope’) and a sample taken to exclude cancer.
For uterine muscle tumours, however, particularly those arising in fibroids, it is often difficult to get a sample. If fibroids are seen particularly in a postmenopausal woman, then a hysterectomy is usually recommended to exclude a malignant tumour (‘sarcoma’).
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ENSURING FULL EVALUATION BEFORE SURGERY – CHECKING YOU

admin — Mon, 18 May 2009 06:57:45 +0000

Steps can be taken to prevent such a situation from arising in the first place. Your surgeon can greatly reduce the chance of finding something unexpected during an operation by checking you carefully beforehand. This means getting a detailed history of your symptoms, examining you carefully, and arranging, with your agreement, whatever tests are necessary to provide a complete picture. In the example I have described, there would probably have been bladder symptoms such as burning, or passing urine more frequently, and/or in smaller amounts than normal. There may have been obvious blood passed or if not, traces of blood would probably have been found in the urine by testing. Special contrast X-rays or endoscopic examination of the bladder (cystoscopy) could have confirmed bladder involvement by the cancer. If the true situation had been established before operating, this person could have had control over the treatment decision, and surgeon would not have been placed in a dilemma.

Here is how to be as sure as possible that your surgeon will be able to carry out the operation you have agreed to. When your surgeon recommends a certain operation, ask how sure he or she is that this operation will be possible. For example, if the aim of the operation is complete removal and possible cure, ask whether the diagnosis of cancer is definite and the exact type known. Ask whether the cancer has already spread into nearby organs. Have the appropriate tests been done to check this? How does your rpe of cancer usually spread? How sure are they that it as not already spread to nearby lymph glands or through the bloodstream? How can the likely sites for secondary growths be checked? These questions apply in the case of potentially curative surgery. Later in this chapter I will give you some idea of what should be known before attempting surgery that has various other aims.

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