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Cervical cancer.
Koh WJ, Greer BE, Abu-Rustum NR, Apte SM, Campos SM, Chan J, Cho KR, Cohn D, Crispens MA, DuPont N, Eifel PJ, Gaffney DK, Giuntoli RL, Han E, Huh WK, Lurain JR, Martin L, Morgan MA, Mutch D, Remmenga SW, Reynolds RK, Small W, Teng N, Tillmanns T, Valea FA, McMillian NR, Hughes M, National Comprehensive Cancer Network
(2013) J Natl Compr Canc Netw 11: 320-43
MeSH Terms: Chemoradiotherapy, Adjuvant, Combined Modality Therapy, Disease Management, Female, Humans, Hysterectomy, Neoplasm Staging, Radiotherapy Planning, Computer-Assisted, Randomized Controlled Trials as Topic, Uterine Cervical Neoplasms
Show Abstract · Added March 10, 2014
These NCCN Clinical Practice Guidelines in Oncology for Cervical Cancer focus on early-stage disease, because it occurs more frequently in the United States. After careful clinical evaluation and staging, the primary treatment of early-stage cervical cancer is either surgery or radiotherapy. These guidelines include fertility-sparing and non-fertility-sparing treatment for those with early-stage disease, which is disease confined to the uterus. A new fertility-sparing algorithm was added for select patients with stage IA and IB1 disease..
0 Communities
1 Members
0 Resources
10 MeSH Terms
Composite uterine neoplasm with embryonal rhabdomyosarcoma and primitive neuroectodermal tumor components: rhabdomyosarcoma with divergent differentiation, variant of primitive neuroectodermal tumor, or unique entity?
Cate F, Bridge JA, Crispens MA, Keedy VL, Troutman A, Coffin CM, Fadare O
(2013) Hum Pathol 44: 656-63
MeSH Terms: Adult, Aneuploidy, Biomarkers, Tumor, Cell Transformation, Neoplastic, Combined Modality Therapy, DNA, Neoplasm, Disease-Free Survival, Female, Humans, Hysterectomy, In Situ Hybridization, Fluorescence, Neoplasms, Complex and Mixed, Neuroectodermal Tumors, Primitive, Rhabdomyosarcoma, Embryonal, Treatment Refusal, Uterine Neoplasms
Show Abstract · Added March 7, 2014
Three cases of composite uterine neoplasms comprised of primitive neuroectodermal tumor (PNET) and rhabdomyosarcoma (RMS) have previously been described, including only one wherein the rhabdomyosarcomatous component was of the embryonal subtype. Whether such composite neoplasms are a variant of RMS, a variant of PNET, or a unique entity is unknown. We report the clinicopathologic, immunohistochemical, and molecular cytogenetic findings in a case of uterine embryonal RMS with coexisting PNET that was diagnosed in a 25-year-old female. The tumor broadly involved the cervix and corpus uteri and resulted in uterine inversion. The 2 distinct components each showed classic morphologic features, including cartilage in the RMS component. The unique combination of histologic, immunohistochemical and molecular findings in composite neoplasms of this type raises a question of whether they should be classified and treated as RMS, PNET, or a unique high-grade sarcoma. A variety of clinicopathologic arguments are presented that support the notion that the current neoplasm is an embryonal rhabdomyosarcoma with divergent neuroectodermal and cartilaginous differentiation.
Copyright © 2013 Elsevier Inc. All rights reserved.
0 Communities
3 Members
0 Resources
16 MeSH Terms
Immediate effects of the initial FDA notification on the use of surgical mesh for pelvic organ prolapse surgery in medicare beneficiaries.
Reynolds WS, Gold KP, Ni S, Kaufman MR, Dmochowski RR, Penson DF
(2013) Neurourol Urodyn 32: 330-5
MeSH Terms: Age Factors, Aged, Aged, 80 and over, Biological Dressings, Cohort Studies, Female, Humans, Hysterectomy, Inpatients, International Classification of Diseases, Medicare, Middle Aged, Outpatients, Pelvic Organ Prolapse, Suburethral Slings, Surgical Mesh, United States, United States Food and Drug Administration, Urologic Surgical Procedures
Show Abstract · Added March 5, 2014
AIMS - Prompted by increased reports of complications with the use of mesh for pelvic organ prolapse (POP) surgery, the FDA issued an initial public health notification (PHN) in 2008. We proposed to determine if the numbers of POP cases augmented with surgical mesh performed in U.S. Medicare beneficiaries changed relative to this PHN.
METHODS - Using administrative healthcare claims for beneficiaries enrolled in the U.S. Medicare program from 2008 to 2009, we identified women who underwent POP surgery with and without surgical mesh by procedural and diagnosis coding. In addition to comparing cases with and without mesh, we also calculated rates (number of cases per 100,000 female beneficiaries) and compared these relative to the timing of the PHN.
RESULTS - We identified 104,185 POP procedures, of which 27,839 (26.7%) included mesh material and 76,346 (73.3%) did not. Between the last three quarters of 2008 and the first three of 2009, the rates of mesh cases increased (40.3-42.1, P < 0.001) and those without mesh decreased (115.5-111.4, P < 0.001). Inpatient procedures decreased and outpatient procedures increased for both those with and without mesh augmentation. For inpatient procedures, the relative use of biologic graft and synthetic mesh material did not vary over the study period.
CONCLUSIONS - A substantial number of Medicare beneficiaries underwent mesh POP procedures in 2008-2009. However, despite the PHN cautioning about potential mesh complications, the numbers of mesh cases continued to rise in the immediate period after the PHN.
Copyright © 2012 Wiley Periodicals, Inc.
0 Communities
2 Members
0 Resources
19 MeSH Terms
Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging.
Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, Sherman S, Sluss PM, de Villiers TJ, STRAW + 10 Collaborative Group
(2012) Fertil Steril 97: 843-51
MeSH Terms: Aging, Anti-Mullerian Hormone, Biomarkers, Drug-Related Side Effects and Adverse Reactions, Endometrial Ablation Techniques, Female, Follicle Stimulating Hormone, Human, Humans, Hypothalamo-Hypophyseal System, Hysterectomy, Inhibins, Menopause, Ovary, Polycystic Ovary Syndrome, Reproduction, Terminology as Topic
Show Abstract · Added February 28, 2014
OBJECTIVE - The aim of this article is to summarize the recommended updates to the 2001 Stages of Reproductive Aging Workshop (STRAW) criteria. The 2011 STRAW + 10 reviewed advances in understanding of the critical changes in hypothalamic-pituitary-ovarian function that occur before and after the final menstrual period.
METHOD(S) - Scientists from five countries and multiple disciplines evaluated data from cohort studies of midlife women and in the context of chronic illness and endocrine disorders on change in menstrual, endocrine, and ovarian markers of reproductive aging including antimüllerian hormone, inhibin-B, follicle-stimulating hormone, and antral follicle count. Modifications were adopted by consensus.
RESULT(S) - STRAW + 10 simplified bleeding criteria for the early and late menopausal transition, recommended modifications to criteria for the late reproductive stage (Stage -3) and the early postmenopause stage (Stage +1), provided information on the duration of the late transition (Stage -1) and early postmenopause (Stage +1), and recommended application regardless of women's age, ethnicity, body size, or lifestyle characteristics.
CONCLUSION(S) - STRAW + 10 provides a more comprehensive basis for assessing reproductive aging in research and clinical contexts. Application of the STRAW + 10 staging system should improve comparability of studies of midlife women and facilitate clinical decision making. Nonetheless, important knowledge gaps persist, and seven research priorities are identified.
Copyright © 2012 American Society for Reproductive Medicine. All rights reserved.
0 Communities
1 Members
0 Resources
16 MeSH Terms
Executive summary of the Stages of Reproductive Aging Workshop +10: addressing the unfinished agenda of staging reproductive aging.
Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, Sherman S, Sluss PM, de Villiers TJ, STRAW+10 Collaborative Group
(2012) Climacteric 15: 105-14
MeSH Terms: Aged, Aged, 80 and over, Aging, Anti-Mullerian Hormone, Biomarkers, Biomedical Research, Endometrial Ablation Techniques, Female, Follicle Stimulating Hormone, Human, Humans, Hypothalamo-Hypophyseal System, Hysterectomy, Inhibins, Menopause, Menstrual Cycle, Middle Aged, Ovarian Follicle, Ovary, Postmenopause, Reproduction
Show Abstract · Added February 28, 2014
OBJECTIVE - The aim of this article is to summarize the recommended updates to the 2001 Stages of Reproductive Aging Workshop (STRAW) criteria. The 2011 STRAW +10 reviewed advances in understanding of the critical changes in hypothalamic-pituitary-ovarian function that occur before and after the final menstrual period.
METHODS - Scientists from five countries and multiple disciplines evaluated data from cohort studies of midlife women and in the context of chronic illness and endocrine disorders on change in menstrual, endocrine, and ovarian markers of reproductive aging including antimüllerian hormone, inhibin-B, follicle-stimulating hormone, and antral follicle count. Modifications were adopted by consensus.
RESULTS - STRAW +10 simplified bleeding criteria for the early and late menopausal transition, recommended modifications to criteria for the late reproductive stage (Stage -3) and the early postmenopause stage (Stage +1), provided information on the duration of the late transition (Stage -1) and early postmenopause (Stage +1), and recommended application regardless of women's age, ethnicity, body size, or lifestyle characteristics.
CONCLUSIONS - STRAW +10 provides a more comprehensive basis for assessing reproductive aging in research and clinical contexts. Application of the STRAW +10 staging system should improve comparability of studies of midlife women and facilitate clinical decision making. Nonetheless, important knowledge gaps persist, and seven research priorities are identified.
0 Communities
1 Members
0 Resources
20 MeSH Terms
A pilot study of microsatellite instability and endometrial cancer survival in white and African American women.
Cote ML, Kam A, Chang CY, Raskin L, Reding KW, Cho KR, Gruber SB, Ali-Fehmi R
(2012) Int J Gynecol Pathol 31: 66-72
MeSH Terms: African Americans, Aged, Aged, 80 and over, Analysis of Variance, DNA, Neoplasm, Endometrial Neoplasms, European Continental Ancestry Group, Female, Genetic Markers, Humans, Hysterectomy, Logistic Models, Michigan, Microsatellite Instability, Microsatellite Repeats, Middle Aged, Neoplasm Staging, Pilot Projects, Prognosis, Retrospective Studies, Survival Analysis
Show Abstract · Added March 5, 2014
Endometrial cancer is the most commonly diagnosed gynecologic malignancy in the United States and can be classified on the basis of various pathologic, molecular, and genetic features, including microsatellite instability (MSI). As MSI is generally associated with a more favorable outcome in colorectal cancers, it is feasible that microsatellite instability may also influence endometrial cancer survival. We examined MSI and survival in 45 African American and 31 white women diagnosed with endometrial cancer at a large, urban cancer center. Fifty-five tumors were classified as type I and 21 tumors were classified as type II. Unconditional logistic regression models found that microsatellite stable tumors were more frequently observed in white women compared with African American women (odds ratio, 8.61; 95% confidence interval, 1.01-73.69). Type I tumors with MSI were not found to be significantly associated with smoking status, tumor stage, or age. Only one type II tumor was classified as MSI. Neither race nor MSI status was a predictor of death from all causes or only endometrial cancer-related deaths were considered in univariate and multivariate survival models. The potential significance of a larger proportion of MSI tumors found in African American women with type I endometrial cancer should be assessed in a larger prospective study.
0 Communities
1 Members
0 Resources
21 MeSH Terms
Complex hyperplasia with and without atypia: clinical outcomes and implications of progestin therapy.
Reed SD, Newton KM, Garcia RL, Allison KH, Voigt LF, Jordan CD, Epplein M, Swisher E, Upson K, Ehrlich KJ, Weiss NS
(2010) Obstet Gynecol 116: 365-73
MeSH Terms: Adult, Aged, Cohort Studies, Endometrial Hyperplasia, Endometrial Neoplasms, Endometrium, Female, Humans, Hysterectomy, Incidence, Middle Aged, Progestins, Retrospective Studies, Risk Factors
Show Abstract · Added March 5, 2014
OBJECTIVE - Limited data exist to inform clinicians and patients as to the likelihood of long-term endometrial hyperplasia response to progestin therapy, especially for atypical hyperplasia. We evaluated women with complex and atypical endometrial hyperplasia, comparing those prescribed progestin with those not prescribed progestin.
METHODS - This retrospective cohort study was conducted in 1985-2005 among women aged 18-88 years at an integrated health plan in Washington State. Women were ineligible if they achieved an outcome (endometrial carcinoma, hysterectomy, or both) within 8 weeks of hyperplasia diagnosis. Exposure was progestin use for at least 14 days by duration and recency. Outcomes included rate of 1) endometrial carcinoma, 2) hysterectomy, or 3) both. Analyses performed included Kaplan-Meier, incident rate ratios, and Cox proportional hazard ratios.
RESULTS - One thousand four hundred forty-three eligible women were identified. One thousand two hundred one had complex (n=164 no progestin) and 242 had atypical (n=62 no progestin) hyperplasia. During follow-up, a median of 5.3 years (range 8 weeks to 20.8 years), 71 women were diagnosed with endometrial carcinoma (35 complex, 36 atypia) and 323 underwent hysterectomy (216 complex, 107 atypia). Among women with complex and atypical hyperplasia, rates of endometrial carcinoma among progestin users were 3.6 and 20.5 per 1,000 woman-years, respectively (compared with women who did not use progestin, 10.8 and 101.4). Among women with complex and atypical hyperplasia, rates of hysterectomy among progestin users were 23.3 and 61.4 per 1,000 woman-years, respectively (compared with women who did not use progestin, 55.1 and 297.3).
CONCLUSION - Endometrial carcinoma risk is diminished approximately threefold to fivefold in women diagnosed with complex or atypical endometrial hyperplasia and dispensed progestin; hysterectomy risk is also decreased.
LEVEL OF EVIDENCE - II.
0 Communities
1 Members
0 Resources
14 MeSH Terms
Uterine Neoplasms. Clinical Practice Guidelines in Oncology.
Greer BE, Koh WJ, Abu-Rustum N, Bookman MA, Bristow RE, Campos SM, Cho KR, Copeland L, Crispens MA, Eifel PJ, Huh WK, Jaggernauth W, Kapp DS, Kavanagh JJ, Lurain JR, Morgan M, Morgan RJ, Powell CB, Remmenga SW, Reynolds RK, Alvarez Secord A, Small W, Teng N
(2009) J Natl Compr Canc Netw 7: 498-531
MeSH Terms: Adenocarcinoma, Brachytherapy, Combined Modality Therapy, Endometrial Neoplasms, Endometrium, Evidence-Based Medicine, Female, Hormone Replacement Therapy, Humans, Hysterectomy, Myometrium, Neoplasm Invasiveness, Neoplasm Metastasis, Neoplasm Recurrence, Local, Neoplasm Staging, Radiotherapy Dosage, Uterine Neoplasms
Added March 10, 2014
0 Communities
1 Members
0 Resources
17 MeSH Terms
Oophorectomy, hormone therapy, and subclinical coronary artery disease in women with hysterectomy: the Women's Health Initiative coronary artery calcium study.
Allison MA, Manson JE, Langer RD, Carr JJ, Rossouw JE, Pettinger MB, Phillips L, Cochrane BB, Eaton CB, Greenland P, Hendrix S, Hsia J, Hunt JR, Jackson RD, Johnson KC, Kuller LH, Robinson J, Women's Health Initiative and Women's Health Initiative Coronary Artery Calcium Study Investigators
(2008) Menopause 15: 639-47
MeSH Terms: Aged, Calcinosis, Coronary Angiography, Coronary Artery Disease, Coronary Vessels, Estrogen Replacement Therapy, Estrogens, Conjugated (USP), Female, Humans, Hysterectomy, Middle Aged, Ovariectomy, Randomized Controlled Trials as Topic, Risk Factors, Tomography, X-Ray Computed
Show Abstract · Added February 15, 2014
OBJECTIVE - Surgical menopause has been associated with an increased risk of coronary heart disease events. In this study, we aimed to determine the associations between coronary artery calcium (CAC) and hysterectomy, oophorectomy, and hormone therapy use with a focus on the duration of menopause for which there was no hormone therapy use.
DESIGN - In a substudy of the Women's Health Initiative placebo-controlled trial of conjugated equine estrogens (0.625 mg/d), we measured CAC by computed tomography 1.3 years after the trial was stopped. Participants included 1,064 women with previous hysterectomy, aged 50 to 59 years at baseline. The mean trial period was 7.4 years. Imaging was performed at a mean of 1.3 years after the trial was stopped.
RESULTS - Mean age was 55.1 years at randomization and 64.8 years at CAC measurement. In the overall cohort, there were no significant associations between bilateral oophorectomy, years since hysterectomy, years since hysterectomy without taking hormone therapy (HT), years since bilateral oophorectomy, and years of HT use before Women's Health Initiative enrollment and the presence of CAC. However, there was a significant interaction between bilateral oophorectomy and prerandomization HT use for the presence of any CAC (P = 0.05). When multivariable analyses were restricted to women who reported no previous HT use, those with bilateral oophorectomy had an odds ratio of 2.0 (95% CI: 1.2-3.4) for any CAC compared with women with no history of oophorectomy, whereas among women with unilateral or partial oophorectomy, the odds of any CAC was 1.7 (95% CI: 1.0-2.8). Among women with bilateral oophorectomy, HT use within 5 years of oophorectomy was associated with a lower prevalence of CAC.
CONCLUSIONS - Among women with previous hysterectomy, subclinical coronary artery disease was more prevalent among those with oophorectomy and no prerandomization HT use, independent of traditional cardiovascular disease risk factors. The results suggest that factors related to oophorectomy and the absence of estrogen treatment in oophorectomized women may be related to coronary heart disease.
0 Communities
1 Members
0 Resources
15 MeSH Terms
Estrogen therapy and coronary-artery calcification.
Manson JE, Allison MA, Rossouw JE, Carr JJ, Langer RD, Hsia J, Kuller LH, Cochrane BB, Hunt JR, Ludlam SE, Pettinger MB, Gass M, Margolis KL, Nathan L, Ockene JK, Prentice RL, Robbins J, Stefanick ML, WHI and WHI-CACS Investigators
(2007) N Engl J Med 356: 2591-602
MeSH Terms: Calcinosis, Coronary Angiography, Coronary Disease, Estrogen Replacement Therapy, Estrogens, Conjugated (USP), Female, Humans, Hysterectomy, Logistic Models, Middle Aged, Multivariate Analysis, Odds Ratio, Postmenopause, Risk Factors, Tomography, X-Ray Computed
Show Abstract · Added February 15, 2014
BACKGROUND - Calcified plaque in the coronary arteries is a marker for atheromatous-plaque burden and is predictive of future risk of cardiovascular events. We examined the relationship between estrogen therapy and coronary-artery calcium in the context of a randomized clinical trial.
METHODS - In our ancillary substudy of the Women's Health Initiative trial of conjugated equine estrogens (0.625 mg per day) as compared with placebo in women who had undergone hysterectomy, we performed computed tomography of the heart in 1064 women aged 50 to 59 years at randomization. Imaging was conducted at 28 of 40 centers after a mean of 7.4 years of treatment and 1.3 years after the trial was completed (8.7 years after randomization). Coronary-artery calcium (or Agatston) scores were measured at a central reading center without knowledge of randomization status.
RESULTS - The mean coronary-artery calcium score after trial completion was lower among women receiving estrogen (83.1) than among those receiving placebo (123.1) (P=0.02 by rank test). After adjustment for coronary risk factors, the multivariate odds ratios for coronary-artery calcium scores of more than 0, 10 or more, and 100 or more in the group receiving estrogen as compared with placebo were 0.78 (95% confidence interval, 0.58 to 1.04), 0.74 (0.55 to 0.99), and 0.69 (0.48 to 0.98), respectively. The corresponding odds ratios among women with at least 80% adherence to the study estrogen or placebo were 0.64 (P=0.01), 0.55 (P<0.001), and 0.46 (P=0.001). For coronary-artery calcium scores of more than 300 (vs. <10), the multivariate odds ratio was 0.58 (P=0.03) in an intention-to-treat analysis and 0.39 (P=0.004) among women with at least 80% adherence.
CONCLUSIONS - Among women 50 to 59 years old at enrollment, the calcified-plaque burden in the coronary arteries after trial completion was lower in women assigned to estrogen than in those assigned to placebo. However, estrogen has complex biologic effects and may influence the risk of cardiovascular events and other outcomes through multiple pathways. (ClinicalTrials.gov number, NCT00000611.)
Copyright 2007 Massachusetts Medical Society.
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15 MeSH Terms