Fertility drugs pose uterine cancer risk?

A new Danish study found some small increase in risk of uterine cancer in those using fertility drugs for long term.

How big is the risk exactly?

If I’m taking fertility drugs, should I be worried?

Which drugs exactly are studied?

What does all this mean?

According to this research paper published in December 2009 in American Journal of Epidemiology,:

1) Women who used follicle-stimulating hormone and human menopausal gonadotropin (hMG) for more than 10 years have a higher risk of uterine cancer.

2) Increase in risk of women taking six or more cycles of clomiphene, an established treatment for women not ovulating normally.

3) Increase in risk of women injected with six or more cycles of human chorionic gonadotropin (hCG), when clomiphene don’t work.

What does this study findings mean?

Do not be alarmed. There is NO big risk in using fertility drugs of developing uterine cancer.

When we are talking about the absolute risk of developing uterine cancer from using fertility drugs, it is very very small. So unless you’ve been using fertility drugs, specifically Clomiphene (trade name: Clomid, Serophene, Milophene etc), for at least 10 years, you shouldn’t be worried about this findings.

But the use of gonadotropins (follicle-stimulating hormone and human menopausal gonadotropin) does increased uterine cancer risk, the risk was primarily observed after 10 years of follow-up.

Again this is a small risk. Discuss with your doctor if you are on gonadotropins or clomiphene for the long term. Most of the time, the benefit outweigh the risks.

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Uterine Cancer Drugs

Using drugs to treat cancer is also known as chemotherapy. Often called "anticancer" drugs, chemotherapy drugs destroy uterine cancer cells by stunting their ability to grow and reproduce. Chemotherapy drugs are usually given intravenously, by injection or by mouth.

More than one drug will probably be used for your treatment. This is called combination chemotherapy. The drugs work together to kill more cancer cells.

Treatment can be once a day, once a week, or even once a month. It depends on the type of cancer you have and the chemo you are taking. How long you get chemo also depends on how your body responds to the drugs.

Some examples of drugs you may recieve:

Progestin theraphy:

Medroxyprogesterone (Provera).

Hydroxyprogesterone (Delalutin)

Chemotheraphy (Anti cancer drugs):

Cisplatin

Carboplatin

Doxorubicin

Topotecan

Anti nauseant and vomiting:

Odansetron

Dolasetron

promethazine

prochlorperazine

You might be aware that there are certain side effects that come with chemotheraphy. Some of the common side effects are:

• hair loss
• fatigue (tiredness)
• increased chance of bruising and bleeding
• anemia (low red blood cell count)
• nausea and vomiting
• infection

Your doctor may prescribe drugs to counter these side effects. That is why it is normal for a patient undergoing chemotherapy to be on a few drugs at a time.

Uterine polyps cancer treatment

If your doctor tells you that you have endometrial polyps / uterine polyps, what does it mean?

Endometrial polyps / uterine polyps is a projection of tissue (lump) in the inner lining of the uterus. They are usually benign and harmless and rarely malignant, though larger ones may be precancerous and cancerous.

Polyps usually form in organs with legions of blood vessels, like the colon and uterus. Detection by normal ultrasound can be difficult. Uterine polyps can be detected by sonohysterogram (water ultrasound).

Polyps cases peak between ages 40 and 50 years, but many cases occur in menopausal women. Only fewer than 1% of cases, polyps are associated with cancer.

Symptoms: Intermenstrual bleeding, excessive bleeding, spotting after intercourse.

Because most polyps are small, they usually do not cause any symptoms. If the polyps interfere with sperms or eggs, it might make it hard to get pregnant.

Multiple case reports indicate that tamoxifen treatment (breast cancer treatment) may stimulate the development and growth of endometrial polyps.

Treatment

Polyps can be removed by performing D & C ( Dilation and cutterage), but the cutterage method may miss the polyps because this method is mainly performed buy feel. The use of a hysterescope allows polyps to be removed through the cervix visually. If the polyps is found to be cancerous, a hysterectomy can be performed. Hysterectomy is the procedure to completely remove the uterus.

After treatment

After removal of the polyps, the patient can return to work after a few days. Spotting may occur for a few days. Polyps may recur years after treatment, but recurrence is usually rare.

Some risk factors of polyps are:

1. Obesity

2. High blood pressure

3. Tamoxifen (breast cancer treatment drug)

A healthy lifestyle can prevent the development of uterine polyps.

Sex After Hysterectomy

Hysterectomy is one of the most common treatment for uterine cancer. Many women fear that after hysterectomy, they might lose their desire for sex. It has been reported that some women feel a reduction in orgasm intensity after hysterectomy . But is this true?

There are a few reasons why a women may fear that hysterectomy will reduce their enjoyment of sex:
1) Hysterectomy may shorten the vagina and some women reported failure to lubricate which can cause discomfort.
2) If the ovaries are removed during the surgery (total hysterectomy), may cause a severe drop in women hormones (estrogen) which may cause vaginal dryness and painful intercourse.

However, in the largest study of it's kind ever conducted, a 1999 study by University of Maryland School of Medicine researchers found quite the opposite is true. The sex life of participants of the study improves positively after hysterectomy. The majority of the 1,101 women who took part in the study was followed up for 2 years after hysterectomy. Overall, the frequency of sexual relations increased after surgery.

The study also found that:
1) Sexual activity increased after hysterectomy
2) Orgasm frequency increased - 72% experienced orgasm after surgery compared with 63% before surgery.
3) Stronger orgasm - women in study reported strong orgasm almost 15% more frequently after surgery.
4) Less pain during sex - Women in the study group experiencing pain during sex drop from 41% before surgery to 15% 2 years after surgery.

All these are good news for women who have fear of the side effects of hysterectomy on their sexual life. Common beliefs that hysterectomy leads to sexual problems are proven to be the opposite by the study. Researchers of the study attributes the improvement in sexual interest to the relief of pain and discomfort from complications of the disease before surgery. The freedom from vaginal bleeding and elimination of pregnancy possibility may also contribute to the improvements.

It is also important to note that not all hysterectomy procedures are the same, thus there will be different effects on the sexual functioning of a woman who has undergone a hysterectomy procedure which removes her ovaries or one which did not. Consult your doctor and have him/her explain to you the full implications and the choices of procedure available to you before you make any decisions.

Laparoscopy-assisted surgery: Effective for endometrial cancer?

A new study published in March 2007 in the American Journal of Obstetrics and Gynecology reported that laparascopy-assisted vaginal hysterectomy (LAVM) is a safe and effective treatment for stage I endometrial cancer in women with a BMI (Body mass index) of less than 35.

In this study, laparoscopic hysterectomy was compared to abdominal hysterectomy, and it gave further evidence from previous studies on the safety and effectiveness of LAVM in early stage endometrial cancer.

Although LAVM took longer to perform than abdominal hysterectomy, the study shows that it is associated with reduced blood loss and shorter hospital stay. The recurrence rate, overall and disease free survival are also slightly lower with the LAVM method but did not show a statistical difference in the study.

This is a great option to explore with your doctor if you are considering surgery.

Endometrial sampling or D and C (Dilation and Currettage)?

In diagnosis of uterine cancer, these 2 methods may be suggested by your doctor, but what is the difference and can you request your doctor to opt for the less invasive procedure?

Basically, the D and C method used to be considered as the gold standard for sampling the endometrium for endometrial cancer. However, it is now recognised as a blind sampling method because it often samples less than half the endometrium. After talking to an O&G (obstetric and gynaecology) specialist the other day, she told me that she would recommend her patients for endometrial biopsy (involving a pipelle) instead because it's less invasive and have a few more advantages:

1) There is no need for a general anesthetic.
2) Lower risks of infection, hemorrhage (loss of blood from bleeding).
3) Saves time for patient and doctor.

A check on the web also reveals news of a latest study, published in March 2007 in the American Journal of Obstetrics and Gynecology that have shown that the use of the pipelle is a very accurate endometrial sampling method.

The sensitivity of Pipelle is than 93% for low grade cancer and 99.2% for high grade cancer.

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So make sure you explore this option with your doctor!

External Radiation Therapy No Benefit in Early Endometrial Cancer

A recent clinical study reported in the American Society of Clinical Oncology meeting has found that external radiation therapy done right after surgery do not show any benefit to patients in extending sutvival or reducing risk of recurrence.

This study, done on women with stage I endometrial cancer involves 906 women who are seperated into 2 study group. They were followed up for everage of 4 years and those who recieved external radiation therapy after surgery do not show any difference in overall or recurrence free survival rate.

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