Best Practice & Research Clinical Obstetrics & Gynaecology
11Hormonal therapies and gynaecological cancers
Section snippets
Background
Endometrial cancer is the most common gynaecological cancer in the Western world, affecting more than 40,000 American women per year, of whom nearly 7000 will succumb to the disease. The majority of women present with Stage I disease following an episode of abnormal bleeding, and the 5-year survival rate for this group is 75%.1 Women presenting with more advanced disease or recurrence have a much poorer prognosis, with a 5-year survival rate of 25%.
The strongest risk factor for endometrial
Role of progestagens
Progestagens were shown to have an anti-oestrogenic effect on the endometrium11 and to produce marked changes in the glands and stroma as early as the 1950s12, which led to the concept that progestagens may be useful in the treatment of endometrial cancer.
Progesterone acts as an anti-oestrogen by reducing oestrogen receptor content and the ability of the endometrium to make new receptors, and by increasing oestradiol dehydrogenase.13 This causes both a suppression of endometrial gland growth
Background
Uterine sarcomas account for approximately 3% of all uterine malignancies.11, 34 They arise from mesodermal tissue. Sarcomas display a more aggressive pattern of disease compared with endometrial adenocarcinoma, and include carcinosarcoma, leiomyosarcoma, endometrial stromal sarcoma and adenosarcoma. Endometrial stromal sarcomas (ESSs) are divided into low- and high-grade categories according to mitotic rate. Low-grade ESSs are considered to be more indolent tumours but recurrence rates are as
Background
Ovarian cancer affects more than 20,000 women in the USA each year. It has the highest mortality of all gynaecological cancers*37, 38 due to the fact that the majority of women present with advanced disease. Overall survival is of the order of 37–44%39, with 5-year survival rates of 80% for Stage I disease and 10–15% for Stage IV disease.38
The exact mechanism of development of ovarian cancer is uncertain, but repetitious ovulatory activity may be a factor in the malignant transformation of the
Summary
A variety of gynaecological cancers respond to hormonal manipulation. The presence of steroid receptors gives a good guide to likely response in endometrial carcinoma and stromal sarcoma, but no such correlation exists with ovarian epithelial malignancies. A lack of trials comparing different agents and combinations, different methods and sequencing of delivery, and different doses has led to a restricted availability of hormonal options in this setting. Future research should be directed at
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Cited by (43)
Phase 2 study of anastrozole in recurrent estrogen (ER)/progesterone (PR) positive endometrial cancer: The PARAGON trial – ANZGOG 0903
2019, Gynecologic OncologyCitation Excerpt :There is evidence that hormonal therapy can be associated with clinical benefit in patients with recurrent/metastatic EC and is widely used to treat a subset of patients. Most work to date has focussed on the role of progestogens and historically response rates of up to 70% were reported in women with PR-positive endometrial cancers compared with 12% in women with PR-negative tumours [2–4]. However, using more rigorous response criteria in clinical trials and institutional studies, the objective response rates are lower and range from 15% to 35% [2,5].
Uterine sarcoma in Tunisia: Retrospective study about 14 cases
2014, Gynecologie Obstetrique et FertiliteHormone therapy in ovarian granulosa cell tumors: A systematic review
2014, Gynecologic OncologyQuantification of ER/PR expression in ovarian low-grade serous carcinoma
2013, Gynecologic OncologyCitation Excerpt :LGSC show a higher prevalence of ER and PR expression compared to HGSC (58% vs 27% for ER, and 43% versus 17% for PR) [8]. The responsiveness of advanced stage ovarian carcinoma to hormonal therapy is modest [9]. However, these results are derived from studies of the most predominant ovarian carcinoma type, HGSC, and are therefore do not address the minority types [10].
Efficacy of oral or intrauterine device-delivered progestin in patients with complex endometrial hyperplasia with atypia or early endometrial adenocarcinoma: A meta-analysis and systematic review of the literature
2012, Gynecologic OncologyCitation Excerpt :Invasive EC can already be found in approximately 30% of patients initially diagnosed with CAH [17]. The current standard treatment for CAH and endometrial cancer is hysterectomy and bilateral salpingo-oophorectomy [18–21] with or without surgical staging [22]. Whilst radical surgery offers good 5-year survival prospects of 75–90% [20], it also eliminates prospects of further fertility.
Effective Luteinizing Hormone Drug Delivery by Nanocarriers in Hormonal Cancer Treatment
2023, Hormone Related Cancer Mechanistic and Nanomedicines: Challenges and Prospects