Komiyama Shinichi, Nishio Eiji, Yasue Akira, Hasegawa Kiyoshi, Udagawa Yasuhiro
Department of Obstetrics and Gynecology, Fujita Health University School of Medicine.
Nihon Rinsho. 2008 Jan;66(1):174-81.
Endometrial cancer is an estrogen-dependent tumor with increasing incidence in recent years. It can be classified into two types: the more common type 1 tumors are estrogen-dependent, develop in relatively younger patients, and are associated with a relatively good prognosis; while type 2 tumors are estrogen-independent, develop in relatively older patients and are associated with a poorer prognosis. On the other hand, with the increase in breast cancer patients in recent years and with the resulting similar increase in patients on oral tamoxifen treatment, there has been a problematic rise in the incidence of endometrial cancers induced by tamoxifen use. This has necessitated a need for careful observation of these patients as tamoxifen-related endometrial cancers are often type 2 cancers and thus present with a poorer prognosis. A large number of hormonal treatments have been used in the treatment of endometrial cancer; however, only progestin derivatives have demonstrated any effect towards endometrial cancer to date. In general, progestin therapy is used only for fertility-preserving purposes in younger patients. These patients must fulfill the indications of well-differentiated endometrioid adenocarcinoma of Stage Ia; in these patients, medroxyprogesterone acetate (MPA) 400-600 mg/day is administered and treatment effects are evaluated by endometrial biopsy every 8 weeks.
子宫内膜癌是一种雌激素依赖性肿瘤，近年来发病率不断上升。它可分为两种类型：较常见的1型肿瘤是雌激素依赖性的，发生在相对年轻的患者中，预后相对较好；而2型肿瘤是雌激素非依赖性的，发生在相对年长的患者中，预后较差。另一方面，近年来随着乳腺癌患者数量的增加以及随之而来的口服他莫昔芬治疗患者数量的类似增加，使用他莫昔芬导致的子宫内膜癌发病率出现了问题性上升。这就需要对这些患者进行仔细观察，因为与他莫昔芬相关的子宫内膜癌通常是2型癌症，因此预后较差。大量激素治疗已被用于子宫内膜癌的治疗；然而，迄今为止，只有孕激素衍生物对子宫内膜癌显示出任何效果。一般来说，孕激素疗法仅用于年轻患者的保留生育功能目的。这些患者必须符合Ia期高分化子宫内膜样腺癌的指征；在这些患者中，给予醋酸甲羟孕酮（MPA）400 - 600毫克/天，并每8周通过子宫内膜活检评估治疗效果。
