Latest Research on endometrial cancer : Jan 2022

Endometrial Cancer

The epidemiology, prevention, diagnosis, treatment, prognosis, and new International Federation of Gynecology and Obstetrics staging system of endometrial carcinoma are reviewed. Endometrial cancer has increased 21% in incidence since 2008, and the death rate has increased more than 100% over the past two decades. Precursor lesions of complex hyperplasia with atypia are associated with an endometrial carcinoma in more than 40% of cases. Endometrial cancer in white women occurs at twice the incidence as in black women, but, stage for stage, black women have a less favorable prognosis. Preoperative imaging cannot accurately assess lymph node involvement. Gross examination of depth of myometrial invasion does not have the sensitivity, specificity, positive predictive value, or negative predictive value to select women who can have lymphadenectomy safely omitted from the surgical procedure. Although surgical staging remains the most accurate method of determining the extent of disease, the therapeutic value of pelvic lymphadenectomy has not been established. The anatomical extent of lymphadenectomy and the number of lymph nodes removed to establish prognostic and therapeutic benefit are controversial. Research efforts are directed at identifying women with early stage endometrial cancer who only require total hysterectomy and bilateral salpingo-oophorectomy. Minimally invasive surgical techniques have become established as standard therapy for treating women with endometrial cancer. Women with a family history of hereditary nonpolyposis colorectal cancer are at increased risk for endometrial cancer. Conservative treatment to allow for childbearing is possible in select situations. Women with endometrial cancer should be managed by physicians experienced in the complex multimodality treatment of this disease.[1]

The epidemiology of endometrial cancer

The descriptive and analytical epidemiology of endometrial cancer is reviewed. Over the last few decades, age-standardized incidence rates have been rising in several countries. The rise has been even greater in terms of absolute numbers of cases, and hence public health implications, due to the aging of the population. Although endometrial cancer rates were found to be higher in richer countries and urban populations, there is now evidence of some changes in the socioeconomic determinants of the disease in developed countries. In etiological terms, any factor that increases exposure to unopposed estrogens (such as menopausal replacement treatment, obesity, and irregular menstrual cycles) tends to increase the risk of the disease, while factors that decrease exposure to estrogens or increase progesterone levels (such as oral contraceptives or smoking) tend to be protective. Less well defined, or more difficult to explain in biological terms, is the role of other factors, such as births, miscarriages, or diabetes and hypertension, and only suggestive evidence is available on diet from analytical epidemiology. The data reviewed herein are discussed in terms of models of carcinogenesis, as well as attributable risks and public health implications.[2]

Epidemiology of endometrial cancer

Endometrial cancer is the commonest gynaecological cancer mostly affecting women in the post-menopausal age group. Rates vary worldwide and are highest in white women in Western populations. Some risk factors are related to reproduction, such as early age at menarche, late age at menopause and nulliparity, while others are more directly oestrogen-related, for example, conditions such as the polycystic ovarian syndrome. Use of unopposed oestrogen replacement therapy is associated with an increased risk, and use of the combined oral contraceptive pill is associated with a decreased risk. The relationship between tamoxifen and endometrial cancer is not established. Obesity, diabetes and hypertension increase the risk of endometrial cancer while smoking, low-fat diets and physical exercise appear to decrease the risk; all of these possibly exert their effects by various indirect influences on oestrogen levels, thus influencing the level of stimulation of the target endometrial epithelium.[3]

Role of Diffusion Weighted Magnetic Resonance Imaging at 3-T in Staging of Endometrial Cancer and Correlation to Histopathology

Aim: To investigate the value of diffusion weighted imaging (DWI) at 3-T MR in staging of endometrial cancer and the correlation to histopathology.

Study Design: A retrospective study.

Place and Duration of Study: CT-MR Division, Qianfoshan Hospital Affiliated to Shandong University. Department of Radiology, Affiliated Hospital of Jining Medical College. From June 2013 to June 2014

Methodology: 30 patients with histologically proved endometrial cancers were analyzed retrospectively. The staging diagnosis of DWI was compared with pathologic results. The ADC values in different histologic types and different differentiated of endometrial cancers were also compared. P<0.05 was considered statistically significant.

Results: The staging accuracy of DWI was 83.3%. The ADC value in 30 patients of endometrial cancer was (0.856±0.080) ×10-3 mm2/s. There was no statistically significant difference in different histologic types (t=1.093,P=0.284). In different differentiated endometrial cancers, there was significant difference (F=97.246,P=0.000).

Conclusion: DWI has considerable value in staging of endometrial cancer. The ADC values can demonstrate the grade malignancy of tumors initially. So diffusion weighted sequences can be included in routine MR protocols for tumor assessment.[4]

Isolation of Hopenone-I from the Leaves of Mangrove Plant Scyphiphora hydrophyllacea and Its Cytotoxic Properties

Aims: The present study was aimed to isolate active anti proliferative compound/s from the hexane extract of leaves of the mangrove plant Scyphiphora hydrophyllacea C.F.Gaertn. and evaluate their cytotoxic properties.

Place and Duration of the Study: At the Institute of Biochemistry, Molecular Biology and Biotechnology and HEJ Research Institute of Chemistry, between January 2015 to November 2015.

Methodology: The hexane extract of the leaves of S. hydrophyllacea which was found to be cytotoxic was fractionated using normal phase column chromatography and fractions obtained from column chromatography were tested for anti proliferative effects. Active fractions obtained were further fractionated using normal phase column chromatography to obtain compound 1. Structure of the isolated compound was elucidated with combination of 1H- and 13C-NMR spectroscopy, and mass spectrometry techniques. Anti proliferative properties of compound 1 in three cancer cell lines {MCF-7 (estrogen receptor positive breast cancer), HepG2 (hepatocellular carcinoma) and AN3CA (endometrial cancer)} was evaluated by MTT assay after 24 and 48 h incubations.

Results: Isolated compound was found to be hopenone-I, a triterpenoid and this is a novel finding for the presence this compound in the mangrove plant S. hydrophyllacea. Hopenone-I showed some promising anti proliferative effects in all the cancer cells in a time and dose dependent manner after 24 and 48 h incubations {MCF-7: 14.98 µM (24 h) and 7.76 µM (48 h), HepG2: 29.24 µM (24 h) and 11.60 µM (48 h), AN3CA: 12.15 µM (24 h) and 4.99 µM (48 h)}.

Conclusion: Based on the overall results of the present study, we conclude that hopenone-I isolated for the first time from S. hydrophyllacea leaves possess prominent anti proliferative effects in MCF-7, AN3CA and HepG2 cell lines.[5]

[1] Sorosky, J.I., 2012. Endometrial cancer. Obstetrics & Gynecology, 120(2 Part 1), pp.383-397.

[2] Parazzini, F., La Vecchia, C., Bocciolone, L. and Franceschi, S., 1991. The epidemiology of endometrial cancer. Gynecologic oncology, 41(1), pp.1-16.

[3] Purdie, D.M. and Green, A.C., 2001. Epidemiology of endometrial cancer. Best practice & research Clinical obstetrics & gynaecology, 15(3), pp.341-354.

[4] Dong, G.Q., Wei, J.C., Deng, K. and Shi, H., 2015. Role of Diffusion Weighted Magnetic Resonance Imaging at 3-T in Staging of Endometrial Cancer and Correlation to Histopathology. Journal of Advances in Medicine and Medical Research, pp.1-7.

[5] Samarakoon, S.R., Fernando, N., Ediriweera, M.K., Adhikari, A., Wijayabandara, L., de Silva, E.D. and Tennekoon, K.H., 2016. Isolation of hopenone-I from the leaves of mangrove plant Scyphiphora hydrophyllacea and its cytotoxic properties. Journal of Pharmaceutical Research International, pp.1-6.

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