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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