V práci, která se zabývá hormonální terapií pacientek s karcinomem prsu, autoři nabízejí přehled péče, která je těmto pacientkám poskytována gynekologem, od prevence a diagnostiky přes monitoraci hormonální terapie první linie. Autoři rozebírají příčiny stoupající incidence karcinomu prsu a historicky nastiňují rozvoj hormonální terapie pacientek. Hlavní část práce je věnována vlivu tamoxifenu na ženský organizmus, zejména na genitální trakt, a rozebrány jsou nežádoucí účinky v gynekologické oblasti, hlavně endometria. Je uvedena retrospektivní studie provedená na Gyn. por. klinice 3. LF UK a zaměřená na detekci patologických nálezů endometria pod vlivem tamoxifenu. Dále autoři vypracovali a uvádějí návrh algoritmu monitorace pacientek s Ca mammae (s dělohou a léčených tamoxifenem) gynekologem. Zmíněny jsou nežádoucí účinky hormonální léčby i úskalí při monitoraci a gynekologické péči o tyto pacientky., Author describes hormonal treatment of breast cancer pacients and review gynaecological care from prevention and diagnostics to monitoring of the first line hormonal treatment. Reasons of increasing breast cancer incidence are discussed and historical overview of hormonal treatment posibilities in pacients with breast cancer is summarized. The main part of the article characterizes influence of tamoxifen into woman organism, especially in her genital tract (endometrium changes) and side effects are analysed. The retrospective trial (Dept.Obst. and Gyn. 3-rd Medical Faculty) focusing pathological changes of endometrium under tamoxifen influence is mentioned. Design of monitoring algorithm of breast cancer patients with intact uterus under treatment of tamoxifen is elaborated. Complications, adverse events and difficulties of this hormonal treatment and gynecological monitoring breast cancer patients (with uterus) are specified., Marie Bendová, Eduard Kučera, and Literatura
Aims: This is the first study carried out to describe the role of fetal microchimerism (FM) in the pathogenesis of uterine cancer. The prevalence and concentration of male fetal microchimeric cells (FMCs) were examined in endometrial tissues in relation to subtypes of uterine cancer, and the histological grade and stage of the tumor. FM occurrence was analyzed in relation to risk factors including hypertension, obesity, type 2 diabetes, dyslipidemia, age at cancer diagnosis and patient pregnancy history. The prevalence and concentration of FMCs were examined in endometrial tissues using real-time polymerase chain reaction, SRY and b-globin sequences as markers for male fetal FMCs and total DNA. The studied group involved 47 type 1 endometrial cancers, 28 type 2 endometrial cancers and 41 benign uterine diseases. Results: While the prevalence of FM was decreased only in type 1 endometrial cancer, compared to benign uterine disorders (38.3% vs.70.7%; OR = 0.257, 95% CI: 0.105 to 0.628, p = 0.003), FMC concentrations did not differ within examined groups. The lower FM prevalence was detected in low grade (grade 1 and grade 2) endometrioid cancer (38.3% vs. 70.7%, OR = 0.256, 95% CI: 0.105 to 0.627, p = 0.003) and in FIGO 1 tumors (40.7% vs. 70.7%, OR= 0.285, 95% CI: 0.120 to 0.675, p = 0.004). No correlation between FM prevalence or FMC concentrations and risk factors was demonstrated. Conclusions: A lower prevalence of male FM seemed to be associated with better prognoses in uterine cancer based on tumor subtype, histological grade and stage of the tumor. and Ilona Hromadnikova, Katerina Kotlabova, Petra Pirkova, Pavla Libalova, Zdenka Vernerova, Bohuslav Svoboda, Eduard Kucera