Treatment of Older Women With Endometrial Cancer: Improving Outcomes With Personalized Care

2016 ◽  
pp. 164-174 ◽  
Author(s):  
Linda Duska ◽  
Armin Shahrokni ◽  
Melanie Powell
Keyword(s):  
Endometrial Cancer ◽  
Older Women ◽  
Practical Implication ◽  
Gynecologic Cancer ◽  
Tumor Biology ◽  
Multidisciplinary Care ◽  
Technical Aspect ◽  
Older Patient ◽  
Personalized Care ◽  
Care Surgery

Endometrial cancer is the most common gynecologic cancer, and with a median age of 62 at diagnosis, it affects a significant number of older women. With increasing age and obesity rates in the world’s population, there is an anticipated concomitant increase in older women with endometrial cancer. Older women are more likely to die of endometrial cancer compared with younger patients. Reasons for this include more aggressive tumor biology, less favorable clinicopathologic features, and more advanced disease. Other factors, however, such as reluctance to offer surgical treatment to the older patient and increased complications of treatment are likely to be important. Management of endometrial cancer requires multidisciplinary care (surgery, radiation therapy, and systemic therapy). For each treatment, the feasibility (related to technical aspect of the procedure/treatment), side effects and safety (related to older-patient factors), and the overall benefit as it pertains to older women with endometrial cancer should be assessed carefully with a multidisciplinary approach. Despite the importance of these issues, the data are limited to answer these issues with clarity. In this article, we will review each treatment modality for older women with endometrial cancer. We will introduce the components of comprehensive geriatric assessment and their practical implication for older women with cancer in general and older women with endometrial cancer specifically.

scholarly journals Survival in endometrial cancer in relation to minimally invasive surgery or open surgery – a Swedish Gynecologic Cancer Group (SweGCG) study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christer Borgfeldt ◽  
Erik Holmberg ◽  
Janusz Marcickiewicz ◽  
Karin Stålberg ◽  
Bengt Tholander ◽  
...  
Keyword(s):  
Risk Factors ◽  
Overall Survival ◽  
Endometrial Cancer ◽  
Minimally Invasive ◽  
Cancer Patients ◽  
Surgical Approach ◽  
Open Surgery ◽  
Gynecologic Cancer ◽  
Multivariable Analysis ◽  
Figo Stage

Abstract Background The aim of this study was to analyze overall survival in endometrial cancer patients’ FIGO stages I-III in relation to surgical approach; minimally invasive (MIS) or open surgery (laparotomy). Methods A population-based retrospective study of 7275 endometrial cancer patients included in the Swedish Quality Registry for Gynecologic Cancer diagnosed from 2010 to 2018. Cox proportional hazard models were used in univariable and multivariable survival analyses. Results In univariable analysis open surgery was associated with worse overall survival compared with MIS hazard ratio, HR, 1.39 (95% CI 1.18–1.63) while in the multivariable analysis, surgical approach (MIS vs open surgery) was not associated with overall survival after adjustment for known risk factors (HR 1.12, 95% CI 0.95–1.32). Higher FIGO stage, non-endometrioid histology, non-diploid tumors, lymphovascular space invasion and increasing age were independent risk factors for overall survival. Conclusion The minimal invasive or open surgical approach did not show any impact on survival for patients with endometrial cancer stages I-III when known prognostic risk factors were included in the multivariable analyses.

scholarly journals LASSO and Bioinformatics Analysis in the Identification of Key Genes for Prognostic Genes of Gynecologic Cancer

2021 ◽  
Vol 11 (11) ◽  
pp. 1177
Author(s):  
Shao-Hua Yu ◽  
Jia-Hua Cai ◽  
De-Lun Chen ◽  
Szu-Han Liao ◽  
Yi-Zhen Lin ◽  
...  
Keyword(s):  
Gene Expression ◽  
Endometrial Cancer ◽  
Pathway Analysis ◽  
Bioinformatics Analysis ◽  
Expression Profiles ◽  
Gynecologic Cancer ◽  
Functional Enrichment ◽  
Lasso Regression ◽  
Potential Biomarker ◽  
Study Gene Expression

The aim of this study is to identify potential biomarkers for early diagnosis of gynecologic cancer in order to improve survival. Cervical cancer (CC) and endometrial cancer (EC) are the most common malignant tumors of gynecologic cancer among women in the world. As the underlying molecular mechanisms in both cervical and endometrial cancer remain unclear, a comprehensive and systematic bioinformatics analysis is required. In our study, gene expression profiles of GSE9750, GES7803, GES63514, GES17025, GES115810, and GES36389 downloaded from Gene Expression Omnibus (GEO) were utilized to analyze differential gene expression between cancer and normal tissues. A total of 78 differentially expressed genes (DEGs) common to CC and EC were identified to perform the functional enrichment analyses, including gene ontology and pathway analysis. KEGG pathway analysis of 78 DEGs indicated that three main types of pathway participate in the mechanism of gynecologic cancer such as drug metabolism, signal transduction, and tumorigenesis and development. Furthermore, 20 diagnostic signatures were confirmed using the least absolute shrink and selection operator (LASSO) regression with 10-fold cross validation. Finally, we used the GEPIA2 online tool to verify the expression of 20 genes selected by the LASSO regression model. Among them, the expression of PAMR1 and SLC24A3 in tumor tissues was downregulated significantly compared to the normal tissue, and found to be statistically significant in survival rates between the CC and EC of patients (p < 0.05). The two genes have their function: (1.) PAMR1 is a tumor suppressor gene, and many studies have proven that overexpression of the gene markedly suppresses cell growth, especially in breast cancer and polycystic ovary syndrome; (2.) SLC24A3 is a sodium–calcium regulator of cells, and high SLC24A3 levels are associated with poor prognosis. In our study, the gene signatures can be used to predict CC and EC prognosis, which could provide novel clinical evidence to serve as a potential biomarker for future diagnosis and treatment.

Gynecologic Cancer InterGroup (GCIG) Endometrial Cancer Clinical Trials Planning Meeting

2013 ◽  
Vol 23 (8) ◽  
pp. 1528-1534 ◽  
Author(s):  
Carien L. Creutzberg ◽  
Henry C. Kitchener ◽  
Michael J. Birrer ◽  
Fabio Landoni ◽  
Karen H. Lu ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Endometrial Cancer ◽  
Gynecologic Cancer ◽  
Cancer Clinical Trials ◽  
Planning Meeting

scholarly journals Cytoplasmic Cyclin E Is an Independent Marker of Aggressive Tumor Biology and Breast Cancer-Specific Mortality in Women over 70 Years of Age

Cancers ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 712 ◽  
Author(s):  
Simon J. Johnston ◽  
Binafsha M. Syed ◽  
Ruth M. Parks ◽  
Cíntia J. Monteiro ◽  
Joseph A. Caruso ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Older Women ◽  
Older Patients ◽  
Cyclin E ◽  
Cohort Analysis ◽  
Tumor Biology ◽  
Biological Factor ◽  
Breast Cancer Specific Survival ◽  
Cancer Specific Survival ◽  
Aggressive Tumor

Multi-cohort analysis demonstrated that cytoplasmic cyclin E expression in primary breast tumors predicts aggressive disease. However, compared to their younger counterparts, older patients have favorable tumor biology and are less likely to die of breast cancer. Biomarkers therefore require interpretation in this specific context. Here, we assess data on cytoplasmic cyclin E from a UK cohort of older women alongside a panel of >20 biomarkers. Between 1973 and 2010, 813 women ≥70 years of age underwent initial surgery for early breast cancer, from which a tissue microarray was constructed (n = 517). Biomarker expression was assessed by immunohistochemistry. Multivariate analysis of breast cancer-specific survival was performed using Cox’s proportional hazards. We found that cytoplasmic cyclin E was the only biological factor independently predictive of breast cancer-specific survival in this cohort of older women (hazard ratio (HR) = 6.23, 95% confidence interval (CI) = 1.93–20.14; p = 0.002). At ten years, 42% of older patients with cytoplasmic cyclin E-positive tumors had died of breast cancer versus 8% of negative cases (p < 0.0005). We conclude that cytoplasmic cyclin E is an exquisite marker of aggressive tumor biology in older women. Patients with cytoplasmic cyclin E-negative tumors are unlikely to die of breast cancer. These data have the potential to influence treatment strategy in older patients.

scholarly journals Endocrine Risk Factors of Endometrial Cancer: Polycystic Ovary Syndrome, Oral Contraceptives, Infertility, Tamoxifen

Cancers ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 1766 ◽  
Author(s):  
Atanas Ignatov ◽  
Olaf Ortmann
Keyword(s):  
Endometrial Cancer ◽  
Polycystic Ovary Syndrome ◽  
Oral Contraceptives ◽  
Polycystic Ovary ◽  
Gynecologic Cancer ◽  
Age At Menarche ◽  
Published Data ◽  
Ovary Syndrome ◽  
Increased Risk

Endometrial cancer is the most common gynecologic cancer and is predominantly endocrine-related. The role of unopposed estrogen in the development of endometrial cancer has been investigated in numerous studies. Different reproductive factors such as younger age at menarche, late age at menopause, infertility, nulliparity, age of birth of the first child, and long-term use of unopposed estrogens during hormone replacement therapy have been associated with an increased risk of endometrial cancer. In contrast, there is a growing body of evidence for a protective role of oral contraceptives. Most of the published data on the association between infertility and polycystic ovary syndrome are inconclusive, whereas the effect of tamoxifen on the risk of endometrial cancer has been well established. With this review, we aim to summarize the evidence on the association between infertility, polycystic ovary syndrome, oral contraceptives, and tamoxifen and the development of endometrial cancer.

Gynecologic Oncologist Perspective About ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer

2017 ◽  
Vol 27 (4) ◽  
pp. 826-831 ◽  
Author(s):  
Polat Dursun ◽  
Ali Ayhan
Keyword(s):  
Endometrial Cancer ◽  
Gynecologic Oncology ◽  
Gynecologic Cancer ◽  
Daily Practice ◽  
Consensus Conference ◽  
Point Of View ◽  
Great Effort ◽  
Care Providers ◽  
Nccn Guidelines ◽  
Huge Impact

AbstractESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer was simultaneously published in 3 prestigious journals and is sure to have a huge impact on the clinical practice of gynecologic oncology community and other gynecologic cancer care providers.It is a tremendous report representative of great effort. Hovewer, as practicing gynecologic oncologists, endometrial carcinoma is the most common clinical entity encountered in our routine daily practice; as such, we find some of the report confusing and object to some of its findings, as detailed in this brief report.We also attempted to summarize the differences between the well-known NCCN guidelines and the ESMO-ESGO-ESTRO Consensus Conference guidelines and try to give the point of view of gynecologic oncologic perspective. It is obvious that differences in the management of endometrial carcinomas will continue to be debated by the scientific community.

Rate and Risk Factors for Surgical Site Infection in Gynecologic Oncology Surgeries at a Tertiary Care Facility in a Developing Country

2017 ◽  
Vol 5 (1) ◽  
pp. 23-27
Author(s):  
Erum S Khan ◽  
Sheikh Irfan ◽  
Natasha Khalid
Keyword(s):  
Risk Factors ◽  
Endometrial Cancer ◽  
Cancer Patients ◽  
Developing Country ◽  
Gynecologic Oncology ◽  
Tertiary Care ◽  
Gynecologic Cancer ◽  
Care Facility ◽  
Site Infection ◽  
Tertiary Care Facility

ABSTRACT Introduction Surgical site infections (SSIs) are among the most common complications in surgical patients and have serious consequences for outcomes and costs. There is a dearth of information on risk factors for developing SSI in patients undergoing gynecologic cancer surgery, and this has not been studied using national data. Objectives The objectives of this study were to estimate the prevalence, preoperative and operative risk factors associated with the higher risk of SSIs in gynecologic cancer patients undergoing surgery in a tertiary care facility in a developing country. Setting Department of Obstetrics and Gynaecology, Aga Khan University Hospitals, Karachi, Sindh, Pakistan. Materials and methods Retrospective record review of gynecologic oncology patients admitted for surgery from January 2015 to December 2015 was performed. Results A total of 100 patients met the inclusion criteria. Of these, 15 were identified with SSIs, which were all found to be of the superficial type. Approximately, 44, 40, and 7% were diagnosed with endometrial, ovarian, and cervical cancers respectively. The mean time from surgery to developing SSI was 12.9 days. Among endometrial cancer, 22.7% (10/44) had SSI compared with 7.5% (3/40) for ovarian cancer and 14.2% (1/7) for cervical cancer. The significant predictors of SSI were body mass index ≥35 (p-value <0.004), endometrial cancer diagnosis, the American Society of Anesthesiologists class more than 3, modified surgical complexity scoring system 3 to 4, and blood sugar levels more than 180 mg/dL within 48 hours after surgery in known diabetics. Conclusion About 15% of patients undergoing laparotomy for gynecologic malignancy developed SSIs. In this study, we identified several risk factors for developing SSI among gynecologic cancer patients. These findings may contribute toward identification of patients at risk for SSIs, and the development of strategies to reduce SSI rate and potentially reduce the cost of care in gynecologic cancer surgery. How to cite this article Khan ES, Irfan S, Khalid N. Rate and Risk Factors for Surgical Site Infection in Gynecologic Oncology Surgeries at a Tertiary Care Facility in a Developing Country. J South Asian Feder Menopause Soc 2017;5(1):23-27.

Gynecologic Cancer Intergroup (GCIG) Consensus Review for Ovarian Germ Cell Tumors

2014 ◽  
Vol 24 (Supp 3) ◽  
pp. S48-S54 ◽  
Author(s):  
Jubilee Brown ◽  
Michael Friedlander ◽  
Floor J. Backes ◽  
Philipp Harter ◽  
Dennis M. O’Connor ◽  
...  
Keyword(s):  
Germ Cell ◽  
Early Stage ◽  
Gynecologic Cancer ◽  
Tumor Biology ◽  
Germ Cell Tumors ◽  
Clinical Trial Design ◽  
Cooperative Groups ◽  
Stage Disease ◽  
Fertility Sparing ◽  
Collaborative Efforts

AbstractMost women diagnosed with malignant ovarian germ cell tumors have curable disease and experience excellent survival with manageable treatment-associated morbidity, related both to tumor biology and improvements in treatment over the last 4 decades. Malignant ovarian germ cell tumors occur predominantly in girls, adolescents, and young women and are often unilateral tumors of early stage, although advanced-stage disease occurs in approximately 30% of patients. Tumors are usually chemosensitive, thereby allowing fertility-sparing surgery in most women with high chance of cure. Differences in practice do exist among providers in various subspecialties and geographic areas. In most settings, collaborative efforts among specialties allow the optimal treatment of women with these rare tumors, and implementation of standard guidelines at an international level should translate to effective clinical trial design, rapid accrual to clinical trials, and universally improved patient outcomes.This consensus guideline represents a summary of recommendations for diagnosis and management that has been agreed upon by cooperative groups worldwide. It builds upon individual publications including previously published summary documents and provides the most current practice standards validated worldwide.

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