What's
New With Uterine Cancer The following are a collection of newer references
that have appeared in recent medical publications and are relevant regarding future
treatment or give further insights into what has been presented above.Tamoxifen
is used in the treatment of estrogen receptor positive breast cancer to prevent
recurrences of cancer. It has been shown to improve survival rates in women with
breast cancer. Unfortunately, one of the side-effects is the development of uterine
cancer (=endometrial cancer). 1. A chlorinated tamoxifen analogue, called
toremifene, has a different metabolism and did not result
in endometrial proliferation or cancer formation (Ref. 5). The authors feel that
toremifene is a safer alternative to tamoxifen with the same breast cancer preventative
effect, but not causing uterine cancer as a side effect. 2. Estrogen receptor
negative uterine cancer is similar in behavior to estrogen receptor negative breast
cancer according to the authors of Ref. 6. They found previously that there is
an overexpression of a specific protein kinase with
hormone independent breast cancer, which is also found in tamoxifen induced uterine
cancers. They postulated that both conditions have a common cause , namely an
overexpression of this specific protein kinase, which leads to a low estrogen
receptor. The authors could prove on samples from 42 patients with uterine cancer
that there was an inverse relationship between estrogen receptor expression and
tumor depth invasion as well as expression of tumor grade. In other words, the
less estrogen receptor there is, the more malignant and the more invasive the
tumor is. Using tests of this specific protein kinase expression in tissue samples
can therefore be used to predict whether a patient will have a good or a bad outlook
(=prognosis). 3. As mentioned above stage III C uterine cancer,
where pelvic and/or paraaortic lymph nodes are present, is particularly difficult
to treat. Ref. 7 analyzed the records of 607 uterine cancer patients,
of which 47 (=8%) had stage III C uterine cancer. Various parameters were examined
to find out whether or not they would be predictive of survival outcome.
The
findings were that age of the patient, depth of tumor invasion into the uterus
and confinement of local metastases to only pelvic lymph nodes, but not beyond,
were parameters that independently influenced survival. On the other hand there
was no relationship to grade of tumor, histology type or whether or not paraaortic
lymph glands were affected. 3-year survivals varied between 39% for the worst
cases (with involvement of disease outside of the pelvic lymph glands) versus
93% for patients where the disease was confined to pelvic lymph glands only. Various
treatment modalities were used to treat: surgery for all patients; radiation,
chemotherapy and progestin therapy for selected patients. This brought the 3-year
overall survival up to 77%. 4. In Ref. 8 another group of
21 patients with stage III C disease (like in the previous study) was followed.
All patients had a surgery with dissection of pelvic and paraarotic lymph nodes.
Depending on the microscopic finding a staged combination therapy was given with
more agressive disease getting all of surgery, radiotherapy and chemotherapy.
Those patients with microscopic nodal disease got radiotherapy following
the surgery. With macroscopic cancer lesions both radiotherapy and chemotherapy
was given following the surgery. Overall survival for microscopic
disease was more than 5 years, for macroscopic disease only 3
years. Both Ref. 7 and Ref. 8 indicate that survival rates can be much improved
from the survival data given for stage III and IV,cited in the 5-year survival
table before. It requires a rational approach as outlined in Ref. 8 by Katz et
al. where the therapy is tailored to the findings during the surgical
procedure. This approach is very similar to ovarian cancer, where
cytoreductive surgery
has led to impressive improvements of survival rates. This link takes you there.
5. The Italian Tamoxifen Prevention study, which
is summarized in Ref. 9, has provided some new insights into breast cancer prevention.
Originally, when hormone replacement therapy(=HRT) was introduced to treat menopausal
symptoms several decades ago with only estrogen as a hormone replacement , it
became apparent that side effects such as breast cancer and uterine cancer could
occur in some patients. The authors of Ref. 9 showed that it is possible
to replace hormones with HRT and to give a reduced amount of tamoxifen at the
same time, and this will reduce both uterine and breast cancer risk. The amount
of tamoxifen was only 10 mg every second day. The HRT included progestins as other
studies had shown that inclusion of his reduced the uterine cancer risk as well.
Using this method it would be safe and effective to do HRT in menopause and at
the same time do chemoprevention of
breast cancer. Using this method side effects are cut down to a minimum
as well, which had a positive effect on compliance (=women continued to take the
medicine). As mentioned above, the newer anti-estrogen medication toremifene
might improve this further.
6.
What nutritional factors are important for development of uterine
cancer? Ref. 10 asked exactly this question. 56,837 women were followed
through the National Breast Screening Study where 221 patients developed uterine
cancer (adenocarcinoma). The body mass index (=BMI) was the only positive
finding that was extremely significant: a BMI of more than 25 carried with it
a 2.7-fold risk for women to develop uterine cancer. An effective
way to reduce the BMI would be to follow the zone diet of Dr.Sears (Ref.3), a
Mediterranean diet or the South Beach diet. 7. Surprisingly other factors
or lack of nutrient supplementation were not a significant risk (total dietary
fiber, various types of fibers, vitamin C, E, A, folic acid, beta-carotene, lutein,
or cryptoxanthin from coffee or tea). Lycopene (a substance found in tomatoes)
and saturated fat showed some reduction of risk. This fits in with the observation
by Dr. Sears that an increased BMI is associated with the syndrome of
insulin resistance meaning that the insulin level is constantly elevated. Saturated
fatty acids can bring insulin levels down to a certain extent, which in combination
with calorie restriction will prevent cancer (Ref.3,
p.126 and 127). 8. Perhaps the most important observation by several anti-aging
physicians is the fact that women who have a balanced hormone replacement with
bio-identical estrogen and progesterone hormones enjoy longer lives with no development
of breast, uterine, colon and other cancers. This fact has been published in the
anti-aging literature between 2000 and 2008. Dr. Lee pointed out that saliva hormone
tests are the only reliable test that reflects the tissue levels of hormones (Ref.13).
Blood tests are often misleading in that hormone levels are often reported to
be low (when tissue levels can be high) prompting the physician to overdose with
hormone replacement. However, using saliva tests to monitor for hormone levels
and keeping the progesterone to estrogen levels at a ratio of 1:200 (level of
progesterone 200-fold higher or more than the estrogen level) will keep estrogen
under control and prevent the development of breast cancer or uterine cancer (Ref.13
and 14). Using bio-identical hormone replacement in menopause (and in andropause
for the male) will likely add 10 to 15 years of cancer-free, productive life to
most people's life expectancy. With this information point 1 and 5 above are outdated.
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