There is increasing evidence that breast cancers contain tumor-initiating cells with stem cell properties. The importance of estrogen in the development of the mammary gland and in breast cancer is well known, but the influence of estrogen on the stem cell population has not been assessed. We

Background: Ovarian cancer has a low incidence, but high mortality due to a habitual diagnosis in advanced cancer stages. Currently, used biomarkers have good sensitivity, but low specificity. Aim: To determine the usefulness of the biomarkers and algorithms used up to now in the screening, diagnosis, response to treatments and identification of recurrence in patients with ovarian masses. Methodology: Systematic search of publications in English in the Medline-PubMed database with the terms: “biomarkers”, “tumour”, “tumour biomarkers”, “marker”, “tumour marker”, “ovarian cancer”, “ovarian”, “Neoplasms”, “cancer”, CA-125 Antigen; Human Epididymis-specific Protein E4; Risk of Malignancy Index (RMI); Risk of Ovarian Malignancy Algorithm (ROMA); Ovarian Neoplasms. Original articles, clinical trials, reviews, systematic reviews and meta-analyses, published between January 2000 and November 2020, were selected to determine the usefulness (among others) of CA 125 and HE4 antigen in ovarian cancer. Results: Finally, 39 transcendental publications were selected to write this article to determine the usefulness of tumour markers and algorithms in ovarian cancer. Conclusions: The usefulness of the tumour markers antigen CA125 and antigen HE4 individually or as a basis for decision-making algorithms has low specificity; however, there is little evidence that confirms their usefulness as markers in ovarian cancer screening.

Differentiation between hypothalamic and pituitary amenorrhea is generally based on the luteinizing hormone-releasing hormone (LHRH) test (whether as a single dose, two consecutive doses, or pulsatile over 5-10 days), together with high-resolution imaging (computed tomography or magnetic resonance) of the sellar region. Long-term administration of gonadotropin-releasing hormone (GnRH) is generally used only for ovulation induction, and not for diagnostic purposes. Here, we report the results of long-term administration of GnRH to 19 women initially diagnosed as suffering from hypothalamic amenorrhea on the basis of LHRH testing and computed tomography imaging. During treatment, subjects received 20-micrograms pulses of GnRH every 90 min, subcutaneously from a portable infusion pump. Fourteen subjects responded (i.e. ovulated) during the first treatment cycle; one subject menstruated but did not ovulate during the first cycle, and the dropped out of the study; the remaining four subjects did not ovulate or menstruate despite at least three treatment cycles. Magnetic resonance imaging of the sellar region of these four subjects revealed pituitary lesions (partially empty sella in three cases, microadenoma in one case) which had not been detected by computed tomography. By contrast, no such abnormalities were detected in the nine responders who agreed to undergo magnetic resonance imaging. These findings suggest that long-term administration of GnRH is of value not only for ovulation induction but also for diagnostic purposes. Specifically, an initial diagnosis of hypothalamic amenorrhea is confirmed if there is a positive ovulation response after two GnRH treatment cycles; otherwise, pituitary amenorrhea should be suspected. Our results also suggest that magnetic resonance imaging is more effective than computed tomography for the detection of partially empty sella.