The CancerWeb Report, What's New In Cancer: September, 1996
Uterine Cancer

• Individual natural levels of steroid hormones and uterine (endometrial) cancer - A study of patients with uterine (endometrial) cancer at seven hospitals in Chicago, IL, Hershey, PA, Long Beach CA, Minneapolis, MN, and Winston-Salem, NC, compared their blood hormone levels with those of matched controls. The results were published in the August 21, 1996 issue of the Journal of the National Cancer Institute. The risk for developing uterine cancer was increased about 3-fold in both premenopausal and postmenopausal women with high levels of the androgenic hormone androstenedione. In postmenopausal women, high levels of estrone and albumin-bound estradiol increased the cancer risk about 2- to 3-fold, whereas high serum sex hormone binding protein, which ties up estrogen in an inactive form, halved the risk. In premenopausal women, estrogen levels, whether total or in the free or protein-bound form, had no relationship at all to risk of endometrial cancer. The increased risk associated with obesity and body fat distribution seemed to depend on other factors in addition to higher estrogen levels. (Potischman, JNCI 88:1127, 1996)

  Editor's Comment: - The question of the relation of excess estrogen to the risk of endometrial cancer is an important one, with implications both for the use of oral contraceptives in younger women and of estrogen replacement in those who are postmenopausal. This study dealt with the innate or endogenous hormones, but it also may help shed light on the overall topic. Perhaps most interesting is the as yet under-explored role of androstenedione, an androgen which is also an intermediate in the formation of estrogen. There is clearly much research remaining to be done on this substance, as well as on the role played by obesity, usually attributed to increased estrogen synthesis by the fat tissue, but which this report suggests, may involve other factors also.

  ---

• Medical review of uterine cancer - The August 29, 1996 issue of the New England Journal of Medicine included a comprehensive review of uterine (endometrial) cancer by Dr. Peter Rose of the University Hospitals of Cleveland. Major factors contributing to the development of this cancer are: excessive estrogen, whether from obesity, polycystic ovary disease, or use of unopposed estrogen, i.e., without at least 12 days of progesterone per month, for treatment of menopausal symptoms; treatment with tamoxifen which has some estrogen action; genetic/family predisposition; and possibly dietary fat consumption. It is usually discovered early because of unexpected bleeding. The likelihood that such bleeding indicates uterine cancer rises rapidly with age from about 9% in the 50s to 16% in the 60s, and up to 60% for those in their 80s. Another suspicious clinical finding, seen by MRI or ultrasound, is a thickened interior uterine lining (endometrium). The article discusses various other prognostic indicators and markers. Treatment is surgical - hysterectomy - for 92-96% of women, additional radiation being given for women at high risk. For widespread disease, hormone therapy based on the type of hormone receptors found, and chemotherapy with cisplatin and doxorubicin with or without carboplatin, or paclitaxel, give useful responses. (Rose, NEJ Med 335:640, 1996)