Hormone therapy after endometrial cancer.

Abstract

Endometrial carcinoma is listed under the absolute contraindications to hormone therapy (HT). According to current opinion, HT after stage I or II is still considered an option, and continuous combined oestrogen/progestogen replacement therapy (CCEPT) would be recommended. However, up to now, only observational studies have been put forward. Although none of these studies have established an increased rate of recurrence or mortality, alternatives such as phytopreparations and tibolone, or particular psychotherapeutic drugs, such as venlafaxine, should be considered for the relief of climacteric complaints. Progestogen-only therapy (PT) particularly has been considered. However, the currently discussed possible progestogen effects regarding an increased risk of breast cancer have to be taken into account. Indeed, the wider discussion about the gestagen effects regarding the risk of breast cancer is to be considered. Generally, after hysterectomy, at least for patients with cardiovascular risk factors, the preference today is to use low-dose oestrogen therapy (patches or gels) instead of CCEPT, and this is also now recommended for patients after endometrial cancer. This is to be noted because of the risk factors for endometrial carcinoma, such as hypertension, obesity, polycystic ovary syndrome (PCO) and diabetes mellitus. However, each form of HT should be only exceptionally recommended, and the patients must be informed about the risks that exist and the use of alternatives.

Risk of depression following uterine cancer: A nationwide population‐based study

“…Hormone replacement therapy can be given after treatment of uterine cancer—this is undoubtedly the most effective and the only causal treatment of menopausal estrogen deficiency symptoms. However, risk of cancer recurrence after HRT is still controversial . We found HRT with cumulative dose DDD ≥168 could significantly reduce the risk of depression.…”

“…After treatment, the abrupt loss of estrogen due to oophorectomy often gives rise to corresponding hormone deficiency symptoms, especially hot flushes, sleep disorders, and depressive mood, greatly reducing quality of life. Consequently, the possibility of hormone replacement therapy (HRT) after uterine cancer would be considered …”

Leptin promotes the proliferative response and invasiveness in human endometrial cancer cells by activating multiple signal-transduction pathways

“…However, it inhibits the growth of pancreatic carcinoma (Somasundar et al 2003), suggesting a differential response of various cancer cells to leptin treatment. Leptin has been shown to have a strong positive association with endometrial cancer in a case control study of incident endometrial cancers in Greece (Petridou et al 2002), and an association between circulating levels of leptin and possible involvement of the leptin receptor in pathogenesis of endometrial cancer (Kaaks et al 2002, Mueck & Seeger 2004, Yuan et al 2004) has been proposed.…”

“…Endometrial cancer is the most common gynecological malignancy in developed countries, with approximately 40 000 new diagnoses each year in the US alone, where obesity is also a major health concern (Abu-Abid et al 2002, Kaaks et al 2002, Mueck & Seeger 2004. Therefore, the effects of obesity on human endometrial cancer represent a critical intersection between these two important health problems.…”