Int J Gynecol Obsrer. International
1991, 36: 76
Federation
of Gynecology
76 and Obstetrics
Estrogen replacement
therapy and endometrial
ACOG
Committee Opinion: Committee Number 80-February 1990
on Gynecologic
There are no definitive data to support specific recommendations regarding the use of estrogen in women previously treated for endometrial carcinoma. However, responses from a survey of members of the Society of Gynecologic Oncologists indicate that 83% of the respondents approved using estrogen replacement therapy in patients with stage I, grade I endometrial cancer; 56% favored using estrogen in cases of stage I, grade II cancer; and 39% would use estrogen in cases of stage I, grade III cancer. The Committee on Gynecologic Practice has concluded that in women with a history of endometrial carcinoma, estrogens could be used for the same indications as for any other woman, except that the selection of appropriate candidates should be based on prognostic indicators and the risk the patient is willing to assume. If the patient is free of tumor, estrogen replacement therapy cannot result in recurrence. If an estrogen-dependent neoplasm is harbored somewhere in her body, it will eventually recur; however, estrogen replacement may result in an earlier recurrence. Prognostic predictors (depth of invasion, degree of differentiation, and cell type) will assist the physician in describing the risks of persistent tumor to the patient.
cancer
Practice
In the absence of estrogen replacement therapy: A well-differentiated neoplasm of endometrioid cell type with superficial invasion would render a risk of persistent disease of approximately 5%. A moderately differentiated neoplasm of endometrioid cell type with up to one-half myometrial invasion would render a 10-15% risk of persistent disease. The risk would increase to 20-30% for adenosquamous cell type and to approximately 50% for serous papillary tumors. A poorly differentiated neoplasm, regardless of cell type, with invasion of over one-half of the myometrium would render a 40-50% risk of persistent disease. Because the metabolic changes of estrogen deficiency are significant, the woman should be given complete information, including counseling about alternative therapies, to enable her to make an informed decision. For some women, the sense of well-being afforded by amelioration of menopausal symptoms or the need to treat atrophic vaginitis or osteoporosis may outweigh the risk of stimulating tumor growth. The need for progestational agents in addition to estrogen is unknown at present.
Copyright 0 February 1990 This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. The American College of Obstetricians and Gynecologists 409 12th Street, SW ??Washington, DC 20024-2188
1991, 36: 76
Federation
of Gynecology
76 and Obstetrics
Estrogen replacement
therapy and endometrial
ACOG
Committee Opinion: Committee Number 80-February 1990
on Gynecologic
There are no definitive data to support specific recommendations regarding the use of estrogen in women previously treated for endometrial carcinoma. However, responses from a survey of members of the Society of Gynecologic Oncologists indicate that 83% of the respondents approved using estrogen replacement therapy in patients with stage I, grade I endometrial cancer; 56% favored using estrogen in cases of stage I, grade II cancer; and 39% would use estrogen in cases of stage I, grade III cancer. The Committee on Gynecologic Practice has concluded that in women with a history of endometrial carcinoma, estrogens could be used for the same indications as for any other woman, except that the selection of appropriate candidates should be based on prognostic indicators and the risk the patient is willing to assume. If the patient is free of tumor, estrogen replacement therapy cannot result in recurrence. If an estrogen-dependent neoplasm is harbored somewhere in her body, it will eventually recur; however, estrogen replacement may result in an earlier recurrence. Prognostic predictors (depth of invasion, degree of differentiation, and cell type) will assist the physician in describing the risks of persistent tumor to the patient.
cancer
Practice
In the absence of estrogen replacement therapy: A well-differentiated neoplasm of endometrioid cell type with superficial invasion would render a risk of persistent disease of approximately 5%. A moderately differentiated neoplasm of endometrioid cell type with up to one-half myometrial invasion would render a 10-15% risk of persistent disease. The risk would increase to 20-30% for adenosquamous cell type and to approximately 50% for serous papillary tumors. A poorly differentiated neoplasm, regardless of cell type, with invasion of over one-half of the myometrium would render a 40-50% risk of persistent disease. Because the metabolic changes of estrogen deficiency are significant, the woman should be given complete information, including counseling about alternative therapies, to enable her to make an informed decision. For some women, the sense of well-being afforded by amelioration of menopausal symptoms or the need to treat atrophic vaginitis or osteoporosis may outweigh the risk of stimulating tumor growth. The need for progestational agents in addition to estrogen is unknown at present.
Copyright 0 February 1990 This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. The American College of Obstetricians and Gynecologists 409 12th Street, SW ??Washington, DC 20024-2188
