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子宫内膜癌诊断及治疗进展
子宫内膜癌是较常见的妇科恶性肿瘤,在美国为22/10万,居女性恶性肿瘤的第4位.
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子宫内膜癌诊治中存在的问题与思考
随着子宫内膜癌研究的不断深入,和对其生物学行为的进一步了解,子宫内膜癌的诊治在观念和方法上有了很多变化,尤其是1988年新的国际妇产科联盟(FIGO)手术病理分期标准的应用,使子宫内膜癌的治疗形成了以手术为主,放疗、化疗和激素治疗为辅的治疗模式.但是,在临床实际工作中,还存有很多问题和分歧,这些问题和分歧常常困扰着妇科肿瘤医生的临床决策.本期<中华妇产科杂志>发表的有关子宫内膜癌诊治的系列研究论文,就是针对目前存在的问题和分歧,从不同层面和角度进行的研究,很有代表性,这对临床医生进一步正确理解子宫内膜癌诊治中存在的问题,规范子宫内膜癌的诊治会有很大的帮助.
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1例子宫内膜癌病人的整体护理
自开展系统化整体护理两年来,我们充分运用护理程序这一科学的工作方法,提出病人现存的或潜在的健康问题,利用护理手段独立或与其他医护人员合作处理病人健康问题及反应,保证病人得到高质量的身心护理.现将1例子宫内膜癌病人的护理过程介绍如下.
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子宫内膜癌的化疗进展
子宫内膜癌是女性常见的恶性肿瘤之一,占女性生殖道恶性肿瘤的20%～30%.近年来发病率明显增加,并呈现年轻化趋势.在欧美等发达国家,子宫内膜癌的发病率已成为女性生殖道恶性肿瘤的首位.据统计,2007年美国有4万例新发子宫内膜癌患者(Jemal A,Siegal R,Ward E,et al.2007).子宫内膜癌的治疗以手术为主,放疗为辅,化疗在子宫内膜痛治疗中的作用一直备受争议,以往仅用于晚期及复发子宫内膜癌的治疗.近年来,国外开展了多项针对早期高危予宫内膜癌术后辅助化疗预防复发的随机对照研究,从而使化疗在早期子宫内膜癌治疗中的应用也得以开展并成为目前研究的热点之一.
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2009年版NCCN子宫内膜癌临床实践指南解读
National Comprehensive Cancer Network(NCCN)肿瘤学临床实践指南是由美国21家顶级癌症中心组成的非营利性学术联盟制订的指南,是美国肿瘤领域临床决策的标准,也已成为全球肿瘤临床实践中应用为广泛的指南.NCCN把临床诊疗指南的内容按推荐指数进行了分级:1级表示该项推荐内容基于高水平的证据,并且在NCCN指南制定成员中具有广泛共识,建议值得信赖.
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Mechanisms of inhibition by aspirin of endometrial carcinoma cell proliferation,migration and invasion
Objective:To investigate the effects and mechanisms of aspirin on the proliferation,migration and invasion of endometrial carcinoma HEC-1A cell lines.Methods:HEC-1A cells were cultured to the exponential phase and treated with different concentrations of aspirin (0.625 mmol/ L,1.25 mmol/L,2.5 mmol/L,5 mmol/L and 10 mmol/L) for 24 to 120 hours.Cell proliferation was assessed by methyl thiazolyl tetrazolium (MTT) assay.The migration and invasion of HEC-1A cells were detected by transwell assay.The protein expressions of vascular endothelial growth factor (VEGF) and ascular endothelial growth factor receptor 2 (VEGFR-2) in HEC-1A cells were determined by western blotting.Results:MTT results showed that aspirin inhibited the growth and proliferation of endometrial cancer cells in concentration and time-dependent manner.Aspirin had a significant inhibitory effect on the migration and invasion of HEC-1A cells (P＜0.05).In addition,aspirin obviously suppressed concentration-dependently the expression levels of VEGF and VEGFR-2 (P ＜ 0.05).Conclusion:Aspirin could inhibit the proliferation,migration and invasion of endometrial cancer cells.The anti-tumor mechanism of aspirin might be related to the inhibition of tumor angiogenesis via blocking the VEGF/VEGFR-2 signaling pathway.
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Seeking for endometrial carcinoma-related genes and their bioinformatics analysis
Objective:Screening and excavating genes and biological information related to endometrial carcinoma (EC),to provide novel means for clinical diagnosis and treatment.Methods:The gene chip data of EC was obtained from the Gene Expression Omnibus (GEO) database,we integrated gene discrepantly expressive gene analysis,enrichment of genic function and pathway analysis,protein-protein interaction (PPI) network and literature mining to predict genes and pathways of EC.Results:Functional enrichment analysis identified 976 differential expression genes were participated in cell cycle regulation,proliferation,biosynthesis,protein phosphorylation and fission biological process,etc.We found eight significantly up-regulated pathways in the microarray datasets,including the MAPK signaling pathway and mTOR pathway,and six down-regulated pathways,including the P53 signaling pathway and cell cycle.Gene protein related interaction network analysis was further performed,and we found twelve distinct genes,including the PCNA and CCND1,these genes were located in key position of EC related network,which may be related to the pathogenesis and progression of EC.Furthermore,there was a high correlation between PCNA and CCND1 with EC by consulting the related literature and data,however,the functional mechanism was uncleared.Conclusion:The pathogenesis and progression of EC may involve in several different pathways and genes,the genes PCNA,CCND1 and MAPK signaling pathway may be valuable.
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Clinicopathological Features of Endometrial Carcino-ma Associated with Lynch Syndrome in China
Background and objective To study the clinicopathoiogical characteristics of Lynch syn＆ome-associated endometrial carcinoma in China.Methods Twenty-seven patients who fulfilled the Amsterdam Criteria Ⅱ were classified as having Lynch syndrome-associated endometrial carcinoma (Group A), and 331 patients without a family history of cancer were classified as having sporadic endometrial carcinoma (Group B).Results There were 81 malignancies in 27 Lynch syndrome-associated endometrial carcinoma families, including colorectal cancer (CRC, 24.7%), endometrial carcinoma (21.0%), liver (12.3%), stomach (9.9%), lung (6.2%), and breast (6.2%) cancers. Mean age at time of diagnosis was 49.7 years in Group A and 56.3 years in Group B (P=0.004). Second primary cancers occurred in 33.3% of patients in Group A and 5.1% in Group B (P<0.0001). "Ihe most common second primary cancers were colorectal cancer (44%) and ovarian cancer (22%). The percentage of obese patients was higher in Group A (P=0.013). There was no difference between the two groups in incidence of diabetes mellitns or hypertension or in histological type and FIGO stage. The 5-year survival rates for Group A and B were 96.2% and 79.6%, respectively. Prognosis for Group A was better than for Group B (P=0.045).Conclusion Some clinicopathologicai features of Lynch syndrome-associated endometrial carcinoma, such as early onset and multiple primary carcinomas, are similar in the Chinese and American/European populations. However, the Chinese population had a unique family cancer distribution that included lung and breast cancers. An increased number of grade 1 endometrioid tumors and a better prognosis imply better biobehavior in Chinese Lynch syndrome-associated endometrial carcinoma. Obesity may be a co-contributing factor for development of Lynch syndrome associated endometrial cancer in China.
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Mitogenic and Anti-apoptotic Effects of Insulin in En-dometrial Cancer Cells Are Phosphatidylinositol 3-ki-nase/Akt Dependent
Background and objective Endometrial carcinoma is the most common gynecologic malignancy in the world. Although the insulin-resistant state or hyperinsulinemia was recently suggested as a potent risk factor for endometrial carcinogenesis and progression, there is only limited supporting evidence and the mechanism is unclear. In this study, we explored the roles of phosphatidylinositol 3-k/nase (PI3K)/Akt signaling pathway in the response of a human endometrial cancer cell line, Ishikawa3-H-12 cells, to insulin.Methods The Ishikawa 3-H-12 cells were serum-starved and then stimulated by insulin at various concentrations and for different time periods. To identify the insnlin-mediated signal pathway in the cells, LY294002, a selective inhibitor of PI3K, was used. The proliferation and the apoptotic rates were determined with methyl thiazolyl tetrazolium (MTT) and flow cytometric assays, respectively.Results The insulin receptor positive Ishikawa 3-H-12 cells had enhanced proliferation upon insulin stimulation in a rinse-and time-dependent manner. The growth promoting effect of insulin was blocked when the cells were pre-incubated with LY294002 for 60 rains.Insulin was able to protect the cells from serum-starvation-induced apoptosis in a concentration-dependent manner, while the anti-apoptotic effects of insulin was reversed by adding LY294002. Treatment with insulin at 1 μM for 15 rain resulted in an increased level of activated Akt The insulin-induced Akt activation was inhibited by LY294002 in a dose-dependent manner.Conclusion Insulin activates PI3K/Akt signaling pathway and is a mitogenic and anti-apoptotic agent for Ishikewa 3-H-12 endometrial cancer cells.
