The estimated lifetime risk for endometrial carcinoma (EC) in hereditary nonpolyposis colorectal cancer syndrome (HNPCC) is 32-60%, thus supporting surveillance. The survival rate of EC patients is, however, favourable questioning the need for surveillance. Yet, the effectiveness of gynecological surveillance remains to be shown. The 2 previously published studies were based on transvaginal ultrasound (TVUS) alone. Intrauterine biopsy has not been tested in surveillance for EC in HNPCC families. The effect of gynecological surveillance was evaluated among 175 Finnish mutation carriers. During 759 person years at risk, there were 503 surveillance visits including TVUS and intrauterine biopsy of endometrium at 94% and 74% of the visits, respectively. EC occurred in 14 cases, 11 of which were diagnosed by surveillance, 8 by intrauterine biopsies. TVUS indicated only 4 EC patients but missed 6 other cases. Intrauterine sampling detected 14 additional cases of potentially premalignant hyperplasia. The stage distribution and survival tended to be more favorable in the 14 EC cases of the surveilled group (no deaths) than in the group of 83 symptomatic mutation carriers of whom 6 died of EC, but with no statistical significance. Four cases of ovarian cancer occurred but none was detected by surveillance in TVUS examinations. In conclusion, EC surveillance in HNPCC seems more effective with endometrial biopsies than with TVUS alone. A definite improvement in survival remains to be shown. The detection of early cancer stages and premalignant lesions offers the opportunity to avoid extensive adjuvant treatment. ' 2006 Wiley-Liss, Inc.Key words: hereditary nonpolyposis colorectal cancer; HNPCC; surveillance; endometrial cancer; hyperplasia Germline mutations in DNA mismatch repair genes cause hereditary nonpolyposis colorectal cancer (HNPCC), which is characterized by the early occurrence of colorectal cancer and some extracolonic cancers of which endometrial carcinoma (EC) is the most common.1 The lifetime risk of EC has varied between 32% and 60% in different estimates.2-4 MSH2 mutation carriers seem to be at higher risk for EC than MLH1 carriers, and MSH6 carriers may be at even greater risk. 5,6 The high risk for EC suggests that prophylactic surveillance may benefit patients with HNPCC.The survival rate of HNPCC-associated EC is favorable. In a group of 125 women fulfilling the Amsterdam criteria, Vasen et al. reported that only 12% died of endometrial cancer.7 Compared with matched sporadic EC cases, Boks et al. found no difference in the survival rate among 50 EC patients from HNPCC families; the overall cumulative 5-year survival rates were 88% and 82% respectively. 8 Thus, the question arises whether the surveillance for EC is at all necessary in HNPCC.Regular surveillance for EC by annual or biannual transvaginal ultrasound (TVUS) scan or endometrial aspiration biopsy has been recommended beginning at age 30-35 years for the early detection of EC or premalignant lesion.9-11 However, the effectiveness of gynecolog...
We have investigated gene amplification of fibroblast growth factor receptor-4 (FGFR4) gene in 30 primary breast tumor samples and 15 gynecological tumor samples. Ten percent of the breast tumors showed 2- to 4-fold amplification. Amplification was found more frequently in estrogen- and progesterone-receptor-positive tumors and in tumors with high lymph-node involvement. Breast tumor samples were also analyzed for the amplification of fgfr3 and erbB2 genes and the chromosome 11q13 located genes hst1/int2/bcl1/sea. erbB2 gene was amplified 2- to 13-fold in 13% of the cases, but no amplification of int2/hst1/bcl1/sea amplicon was found. Gynecological tumors were also analyzed for the amplification of fgfr4 and fgfr3 genes and for int2 and hst1 oncogenes. Eleven of the 15 gynecological tumors were ovarian neoplasms including 2 benign tumors; the remainder comprised 1 ovarian metastasis of breast cancer; 1 endometrial cancer; 1 uterine leiomyosarcoma and 1 carcinosarcoma of the fallopian tube. In gynecological tumors, fgfr4 gene was found to be amplified in 2 ovarian tumors. Amplification of hst1 was found in 1 benign ovarian tumor. Thus, the fgfr4 gene may be involved in breast and ovarian tumorigenesis.
Summary
Smoking a standard cigarette caused an acute decrease in intervillous placental blood flow. This change normalized within 15 minutes. At the time intervillous blood flow was depressed, heart rate and blood pressure were elevated and remained so throughout the study period. Repeated decreases in the intervillous blood flow could explain growth retardation of the fetus and some other complications of pregnancy in women who smoke.
The only relevant staging procedure is the histological examination of cervix without the preoperative irradiation. According to our results it seems that simple hysterectomy instead of radical (Wertheim operation) hysterectomy may be a sufficient operative treatment of stage II endometrial carcinoma.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.