OVARIAN CANCER

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Preventive Ovariectomy what age should paragraph For what age women should be preventive ovariectomy, between different gynecological physician there is a considerable difference. Jacobs Or...

I. Overview

With the aging of the global trend of development, improve the economic status of women, more and more women start hormone replacement therapy (Hormone Replacement Therapy, HRT), to improve access to after menopause due to the decrease in the level of sex hormones related to various diseases. Clear evidence that: postmenopausal women with age, the incidence of coronary heart disease increased by about four times the fracture due to osteoporosis by 20%, died of complications due to pelvic fracture rate of 30%, after the 65-year-old Alzheimer's incidence rate increase every year <BR> and Application HRT can peer groups coronary heart disease risk 50% Alzheimer's risk reduced three times, especially worth mentioning is significantly reduced the incidence of rectal cancer. Long-term use of HRT cancer risk reduced year by year. HRT can also greatly improve the menopause, postmenopausal women with disease or ovarian surgery, radiotherapy in patients with a series of artificial menopause syndrome.

In recent years, gynecological cancer incidence trends were younger, as early diagnosis and extensive surgery scope and standard of radiotherapy applications, improved survival rates, however, susceptible to the disease after menopause also significantly higher than healthy people the same age, people's expectations in life, has extended more the high quality of life, therefore, this group of high-risk groups how reasonable application of HRT treatment and prevention of diseases related to it is particularly prominent.

Compatibility of the hormone HRT often divided into estrogen replacement therapy (ERT estrogen replacement therapy), and estrogen and progesterone replacement therapy (estrogen progesterone replacement therapy EPRT). Experimental studies show that estrogen for the receptor with its target cells (endometrial glandular epithelium of the breast glandular epithelial ovarian cancer cell line) to the proliferation and differentiation, clinical manifestations are as follows: long-term use of postmenopausal ERT, about 50% of patients with endometrial hyperplasia, 1.6 ~ 2.5% for the development of adenocarcinoma; there can be induced mammary gland dysplasia or cystic changes, increase breast cancer cell mitosis rate, therefore, estrogen also is considered a potential carcinogen accelerator. It is in view of this, HRT is like a double-edged sword, how to choose the right crowd, application of individual programs, adequate balance between the pros and cons on HRT and mutual constraints Gynecologic Oncology, is becoming a hot spot.

2, endometrial cancer

Healthy menopausal women taking exogenous estrogen can increase the incidence of endometrial cancer rate, and non-users, to the risks associated with RR (relative risk) to 3.0, and long-term (six years) to take the RR to 12.3 (CI 2.6 -59.8). But ERT majority of endometrial cancer differentiation and high-curable superficial.

Since the beginning of the 1970s HRT, USAF Medical Center of ERT in postmenopausal women at the same time cyclical plus progesterone to the uterus endarterectomy to prevent endometrial cancer perspective, after 30 years of experiments, Beresford; Taking EPRT the health of postmenopausal women endometrial cancer associated risks 1.3 (CI 0.8-2.2) and take five years or more RR2.5 (CI1.1-2.5), Persson and others reported 1.0 (CL G8) The investigation the USAF support of the view, but also that the addition of progesterone and estrogen can not be carcinogenic risk to the non-HRT and the same crowd.

The majority of patients with endometrial cancer diagnosis when I, Phase II, the standard treatment after the five-year survival rate is over 80%, and this group of people suffering from fractures caused by osteoporosis and cardiovascular disease is more than three times the ordinary people. About 25% of patients in the diagnosis of pre-menopausal, of which 5% in the following 40 years, the conventional surgical program to this group of people to enter menopause early. Ever since high levels of estrogen and endometrial cancer are closely related, endometrial cancer patients after application of HRT has been a taboo. In recent years, HRT is used to explore such "high-risk groups" the possibility Creasman, reported 221 cases (for the clinical stage IA, IB period, cell grade 1.2) endometrial cancer after 47 cases of ERT, the average time taken for 26 months the tumor grade, endometrial invasion, lymph node metastasis, and pelvic cytology after age parameters of the standard statistical discovery; ERT and the subjects did not increase the rate of tumor recurrence, contrary to the non-treated group over the higher rates but ERT group. Another review of the investigation report: 123 cases of endometrial carcinoma of the right of ERT had no effect on survival, and not the same. Baker, 31 cases of endometrial cancer in postmenopausal patients of ERT also found no negative effects. Although the report is encouraging, but more than a retrospective, small sample sizes, HRT used for endometrial cancer patients with a history of safety to be more forward-looking, random surveys to confirm that.

3, ovarian cancer

High levels of gonadotropin postmenopausal ovarian epithelial cells continue to stimulate is considered one of the reasons for its malignant and therefore, theoretically, have reason to believe that ERT, EPRT applications could reduce the risk of ovarian cancer, but epidemiological investigation did not support the view Burger taking HRT report less than five years with ovarian cancer risks associated with the effects of long-term use are between 0.52-1.71 in the RR, while epidemiological investigation also confirmed that taking ERT does not add to the health of women suffering from ovarian cancer risk.

Since about 60% of ovarian cancer in the estrogen receptor could be detected 50% of progesterone receptor positive, 70% were detected androgen receptor and gonadotropin receptor and gonadotropin releasing hormone receptor, ovarian cancer is considered a type of hormone-related tumors, ovarian cancer so doctors HRT patients with caution, Eeles of 373 cases under the age of 50 epithelial ovarian cancer patients, including 78 patients with ERT, found that ERT had no effect on their survival, but has greatly enhanced the quality of life of patients and EPRT ERT and the same effect, but right ovarian endometrioid carcinoma patients, the authors recommend EPRT might be more appropriate.

4, cervical cancer

The incidence of cervical cancer with no obvious correlation between sex hormones, it is of healthy women, HRT does not increase the incidence of cervical cancer. Smith, HRT does not increase the application of human papilloma virus infection, in other words, not indirectly contribute to the occurrence of cervical cancer.

In recent years, the incidence of cervical cancer is the trend of younger, radical operation to a wide range of patients with significant decline in quality of life, how to improve this situation in order to obtain better treatment effect of Gynecologic Oncology doctors must consider. Cairu Li on 46 cases of patients with early cervical cancer after long-term follow-up survey found that the application of HRT in patients with a higher quality of life and an important guarantee.

5, breast cancer

Right there with heart disease and osteoporosis levy tendencies, low-risk breast cancer with HRT crowd will be more advantages than disadvantages, and the right is suffering from breast cancer risk factors (family history, history of benign breast, menopause after age 50, without fertility history, high fat diet, obesity, or BRAC2 gene BRCA1 mutations) crowd , HRT is still needed careful consideration.

The duration of HRT and breast cancer is closely related to happen, a survey showed that HRT users to the risk of suffering from breast cancer every year, the rate increased 2.3%, however, five years from the risk of breast cancer is still relatively low. Secondly, the types of estrogen intake and breast cancer is a way to the relevant factors. Diethylstilbestrol a coupling of estrogen (Premarin of) more carcinogenic risk (20%), intravenous injection of estrogen oral cancer risk is 4 times.

Despite the HRT increased breast cancer incidence is still controversial, but prefers to use HRT10 years did not increase the risk of breast cancer, and 10 above, the risk factors in patients with breast cancer increased by only 1.3-1.5.
Some scholars believe that HRT is due to regular screening for breast cancer prevention, therefore, would be able to detect early, localized cancer, which is more advanced when found.

The crowd of breast cancer after HRT is usually worries residual cancer cells promote their growth and metastasis, but there are still people in this regard and a bold attempt to: Eden on 167 patients with breast cancer after HRT patients with follow-up time was 7.3 years on average, of which only 16 cases of relapse and the control group 31 cases, the relative risk of recurrence of 0.59 (CI 0.29-0.91) Cobleigh ERT concluded a series of reports that do not increase the chance of breast cancer recurrence or affect the survival rate of Tamoxifen and combined with estrogen, which can reduce the breast cancer cell growth-promoting role.

Six other tumor

Because tubal cancer, uterine cancer, vulvar cancer incidence rate lower tumor originated in squamous epithelium, and the relationship between HRT less.

7, Prospect

Given the estrogen in HRT in the duality of the pros and cons, people trying to find new, higher target of the conventional estrogen replacement drug, the study found that organizations in different organizations, α-mainly in the breast and uterus, β - mainly in the bone and vascular wall. Therefore, people have been exploring these differences will take HRT cancer risk to the minimum alternative, or selective estrogen receptor modulators (SERMS selective estrogen receptor modulators), SERMS on bone tissue and serum lipoproteins in some estrogen-like effect on the breast and uterus, as estrogen performance hormone antagonist role. Inhibition of vascular smooth muscle cell proliferation in vitro experiments have confirmed SERMS right breast cells antagonize estrogen-like effect. Raloxifene is currently commercialized SERMS, would effectively prevent bone loss, prevention of osteoporosis and fractures to induce protective body produce blood lipoprotein HDL, the role of breast cancer prevention. C-reactive protein and homocysteine is considered the occurrence of cardiovascular disease and the important risk factors. Walsh used a double-blind randomized controlled method and 390 healthy postmenopausal women were divided into three groups: conventional HRT group (0.625mg times of the US / d 2.5 mg of progesterone Palace / d), raloxifene (60 ~ 120mg / d) group and the placebo group, for a period in June. HRT may significantly higher levels of C-reactive protein (p <0.001), while raloxifene group had no significant change in the two groups can significantly reduce homocysteine levels, there was no significant difference between the groups.

It is hoped that with the right mechanism of tumor-depth study revealed that estrogen-mediated tumor way to develop a corresponding inhibitors, a fundamental resolution of the potential carcinogenic effects of HRT. Despite the application of HRT, there are many controversial, but clinicians should adopt a positive attitude, repeatedly balance, combined with characteristics of the individual, rational application done.

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