Endometrial cancer

1
Endometrial cancer

• rarely detected by pap smear
• pelvic exam required for diagnosis
• typically slow to metastasize
• treatment hysterectomy possible chemotherapy
• 5 yr survival rate 85

2
Endometrial cancer

• rarely detected by pap smear
• pelvic exam required for diagnosis
• typically slow to metastasize
• treatment hysterectomy possible chemotherapy
• 5 yr survival rate 85

3
Ovarian Cancer

• can occur anytime after puberty, but most often
  after menopause
• Previously difficult to detect no symptoms
  until advanced stages
• before detection, often spreads to ovarian,
  uterine, peritoneal cavity

4
Ovarian cancer

• risk factors BRAC 1 gene smoking
• combination pills, bearing children seems to
  lower risk
• blood test CA-125
• new diagnostic measure test for levels of
  lysophosphatidic acid (LPA)

5
Smoking

• THE major cause of cancer
• Quitting smoking reduces risk more than all other
  methods combined
• Lung cancer is most common cancer in women
• Female smokers 2x more likely to get lung cancer
  (smaller lungs)

6
Smoking

• Women may be more genetically vulnerable to
  tobacco smoke
• Smokers at increased risk for all gynecologic
  cancers
• Nonsmoking women with husbands who smoke have
  higher cancer rates

7
Prevention

• Increase consumption of plant foods
• Decrease consumption of fats
• Exercise!
• Minimize time in sun
• Reduce alcohol consumption

8
Menopause

• not a disease state
• 10-35 of women seek medical help
• symptoms often reflect social / personal
  circumstances

9
Biology of Menopause

• permanent cessation of menstrual cycles
  following a decrease in ovarian activity
• median age 51.3
• perimenopause (climacteric) begins in 40s
• characterized by a decrease in steroid hormone
  production in ovaries

10
Biology of Menopause

• estradiol levels decrease estrone is predominant
  form of E
• adrenals and ovarian stromal cells make
  androstenedione
• converted in blood, fat to estrone
• women with more body fat have fewer menopausal
  symptoms

11
What causes menopause?

• hypothesis 1 decreasing number of follicles
• hypothesis 2 hypothalamic changes
• FSH increase precedes dramatic loss of follicles
• No effect of contraceptives on age of menopause
• Young gonadectomized mice remain fertile upon
  ovarian transplants from postmenopausal mice

12
Effects of decreased E hot flashes

• hot flashes increased skin (and sometimes core)
  temp
• Typical duration 5-10 min up to 1 hour
• decreased E lowers hypothalamic thermostat?
• Lack of correlation between E levels and
  incidence of hot flashes

13
Hot flashes, contd.

• Most begin within 1 yr of last period
• May occur over 4-7 years
• LH, ACTH, GH increases precede hot flash
• Cortisol is elevated after hot flash
• Population differences
• Smoking, low educ., negative attitude increase
  risk
• Roles of physical activity, phytoestrogens
  unclear

14
Hot flashes

• Roles of serotonin, endorphins, norepinephrine
  (NE)?
• NE plays role in thermoregulation
• Inject into preoptic hypothalamus peripheral
  vasodilation, heat loss, decline in core body
  temp
• Block with clonidine reduced heating time and
  number of hot flashes
• E withdrawal increase NE levels in brain

15
Effects of decreased E

• vaginal changes
• changes in bone remodeling
• E inhibits osteoclast activity
• E aids in calcium reabsorption
• E opposes parathyroid hormone action

16
Effects of decreased E

• cardiovascular changes
• treatment estrogen replacement therapy (ERT)
  or hormone replacement therapy (HRT)

17
Cardiovascular disease in women

• overall, ratio of male to female deaths from cv
  disease is 5 to 1
• After menopause, females risk is equal to males
• hypothesis E exerts protective effect

18
CV disease in women

• evidence Johns Hopkins 1987 study showed 70
  decrease in cv disease among ERT users
• how?
• ERT increases HDL levels
• may lower stress levels

19
CV disease in women, contd.

• Cardioprotective effects are lost with HRT
• Data from Women's Health Initiative suggest that
  treatment with HRT has no clinically meaningful
  effect on women's health-related quality of life

20
CV disease

• Long-term HRT use may have health risks (stroke,
  cancer)
• other ways to lower risk
• exercise!
• HDL levels increase in women who walk 3 miles a
  day, 5 days a week (6 months)