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CANCER OF THE UTERINE
ENDOMETRIUM –
ADVANCES AND
CONTROVERSIES
Edited by J. Salvador Saldivar
Cancer of the Uterine Endometrium – Advances and Controversies
Edited by J. Salvador Saldivar
Published by InTech
Janeza Trdine 9, 51000 Rijeka, Croatia
Copyright © 2012 InTech
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Technical Editor Teodora Smiljanic
Cover Designer InTech Design Team
First published February, 2012
Printed in Croatia
A free online edition of this book is available at www.intechopen.com
Additional hard copies can be obtained from orders@intechweb.org
Cancer of the Uterine Endometrium – Advances and Controversies,
Edited by J. Salvador Saldivar
p. cm.
ISBN 978-953-51-0142-0
Contents
Preface IX
Part 1 Biology and Genetics 1
Chapter 1 Molecular Biology of Endometrial Carcinoma 3
Ivana Markova and Martin Prochazka
Chapter 2 The Role of ErbB Receptors in Endometrial Cancer 23
Adonakis Georgios
and Androutsopoulos Georgios
Chapter 3 Hereditary Endometrial Carcinoma 39
J. Salvador Saldivar
Part 2 Modern Imaging and Radiotherapy 55
Chapter 4 Diagnostic Value of Dynamic
Contrast-Enhanced MRI in Endometrial Cancer 57
Ting Zhang, Ai-Lian Liu, Mei-Yu Sun, Ping Pan, Jin-Zi Xing
and Qing-Wei Song
Chapter 5 Modern External Beam Radiotherapy
Techniques for Endometrial Cancer 77
Ruijie Yang and Junjie Wang
Part 3 Surgery and Staging 85
Chapter 6 Controversies in the Surgery
of Endometrial Cancer 87
F. Odicino, G.C. Tisi, R. Miscioscia
and B. Pasinetti
Chapter 7 Controversies Regarding the Utility
of Lymphadenectomy in Endometrial Cancer 101
Frederik Peeters and Lucy Gilbert
VI Contents
Part 4 Therapeutic Strategies 121
Chapter 8 Treatment Strategies and Prognosis
of Endometrial Cancer 123
Gunjal Garg and David G. Mutch
Chapter 9 Reducing the Risk of Endometrial Cancer in
Patients Receiving Selective Estrogen
Receptor Modulator (SERM) Therapy 149
Victor G. Vogel
Chapter 10 Adjuvant Chemotherapy for Endometrial Cancer 167
N. Susumu, H. Nomura, W. Yamagami, A. Hirasawa, K. Banno,
H. Tsuda, S. Sagae and D. Aoki
Preface
Cancer of the uterine endometrium is the most common gynecological cancer in
developed countries, and the most common gynecologic cancer in the USA. Obesity,
diabetes and a hyper-estrogen state are common risk factors associated with the
majority of uterine cancer cases. Although most women with endometrial cancer are
diagnosed at an early stage, it is still a significant cause of gynecologic cancer-related
morbidity and mortality. The primary treatment of endometrial cancer is surgical,
however, there still remains controversy regarding the survival benefit following
complete lymphadenectomy. Further, the roles of combination chemotherapeutic
agents, radiotherapy techniques and hormonal treatment are continually evolving.
This first edition of Cancer of the Uterine Endometrium - Advances and Controversies
brings together an international collaboration of authors to attempt to address these
issues. Effective treatment of any gynecologic cancer is best approached via a
multidisciplinary model that includes physicians, scientists and oncologic personnel,
among others, to improve the outcome for women. The book is divided into four
sections in an attempt to emulate this multi-faceted model of collaboration: 1) Biology
and Genetics, including hereditary endometrial cancer; 2) Modern Imaging and
Radiotherapy; 3) Surgery and Staging; and 4) Therapeutic Strategies. Each section
brings forth the most relevant and evidence-based information for the diagnosis and
treatment of endometrial cancer. In addition, controversies regarding therapeutic
strategies are addressed in the context of the latest clinical studies.
This book is not intended to cover the basics of endometrial cancer. For this, one
should refer to a number of excellent gynecologic oncology textbooks. Rather, the
vision of this book is an international expert collaboration of the most updated
advances in the biology, genetics, diagnosis, imaging, and treatment strategies for
cancer of the uterine endometrium. Ultimately, it is hoped that this opens a platform
for which other authors may add their work in future editions of this book. It is meant
for all learners who care for women with this gynecologic cancer. It is dedicated to our
women patients, our best teachers.
Asst. Prof. Dr. J. S. Saldivar MD, MPH
Division of Gynecology Oncology,
TTUHSC-El Paso, Texas
USA
[...]... of the cycle is mostly under the influence of oestrogens that stimulate proliferation of epithelial and stromal endometrial components, whereas during the secretory stage the main function 16 Cancer of the Uterine Endometrium – Advances and Controversies of progesterone is glandular differentiation and glycogenesis with inhibition of oestrogenmediated proliferation Just as the ovarian steroids play an... determining the appropriate therapy 18 Cancer of the Uterine Endometrium – Advances and Controversies The significance of various immunohistochemical parameters for the prognosis in patients suffering from endometrial carcinoma has not been unambiguously determined yet The aim is, by applying the information acquired based on the expression of tumour biomarkers, to limit the radicalism in surgical and radiation... that the expression of MMP-26 specifically fluctuates during the menstrual cycle The detection of high levels in the middle of the cycle and in hyperplastic endometrium, and, on the other hand, low levels in the late stage of the cycle and endometrial carcinoma indicate the correlation with oestrogen receptors Isaka et al and Pilka et al demonstrated a significantly reduced expression of MMP-26 in endometrial... PMS1 and PMS2 ) among the tumour suppressor genes The vast majority of patients 12 Cancer of the Uterine Endometrium – Advances and Controversies carry so called Lynch syndrome, also known as HNPCC (hereditary nonpolyposis colorectal cancer) HNPCC is a familial cancer syndrome caused by mutations in one of five different genes for DNA repair responsible for the repair of DNA segments in which the correct... various types of repetitive sequences, i.e DNA sections of various length that appear in many copies at various places of the genome Most of them are products of reverse transcription and thus they have a crucial effect on the structure of the genome in Molecular Biology of Endometrial Carcinoma 13 humans and other organisms The importance of the repetitive sequences probably lies in maintaining the chromosomal... loss of function in both alleles of a certain gene, are identified as tumour suppressor genes They regulate cell division or are involved in contact inhibition of cell growth - they function as "safety fuses" which turn off the cell cycle if exposed to 8 Cancer of the Uterine Endometrium – Advances and Controversies abnormal proliferation or damage to genetic information Their protein products check the. .. domain and an intracellular domain with tyrosine kinase activity [Riese et al., 2007; Yarden, 2001a; Yarden & Sliwkowski, 2001b] They catalyze the transfer of the γ phosphate of ATP to hydroxyl groups of tyrosines in target proteins [Hunter, 1998] ErbB-3 lacks intrinsic tyrosine kinase activity [Mass, 2004] 24 Cancer of the Uterine Endometrium – Advances and Controversies The extracellular region of ErbB... during the excessive and mostly chaotic and imprecise division, other changes are cumulated and new characteristics acquired Therefore, the metastatic cells do not reveal different genetic changes than the cells of the original tumour However, all these cells emerged through the division of a single originally maligned cell and thus the tumour is termed as monoclonal The above indicates that the complex... diagnosis of cancer, together with individual "custom-made" therapy, may reduce mortality and improve the prospects and quality of the patient's life Gynaecological malignant tumours represent a group of diseases where the prognosis depends on subtle genomic, epigenetic and proteomic changes The application of molecular biology techniques, including analysis of methylation and acetylation, and preoteomic... damaged DNA The original clone of neoplastic 4 Cancer of the Uterine Endometrium – Advances and Controversies cells may, in this way, develop into many sublines with a different degree of malignity Thus, the cell clone able to survive is selected, i.e clonal selection Such tumorous cells generally acquire the ability of invasive growth and metastases Each malignant tumour is a mixture of cells with . CANCER OF THE UTERINE
ENDOMETRIUM –
ADVANCES AND
CONTROVERSIES
Edited by J. Salvador Saldivar
Cancer of the Uterine Endometrium. obtained from orders@intechweb.org
Cancer of the Uterine Endometrium – Advances and Controversies,
Edited by J. Salvador Saldivar
p. cm.
ISBN 978-953-51-0142-0
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