The evaluation of diagnostic and clinical findings in grand multiparous patients with endometrial cancer

Öz

Objective: The aim of the present study is to evaluate differences in diagnostic and clinical characteristics of the grand multiparous patients with endometrial cancer comparing with the other patients with endometrial cancer. Methods: A total of 34 patients that operated for endometrial cancer between January 2006 and August 2012 in our clinic were included. The patients were divided into three groups according to the number of births; group 1 (nulliparous patients, n=8), group 2 (the number of delivery from one to four, n=12), group 3 (grand multiparous patients, n=12). The diagnostic, clinical and histopathological data of the patients in the group 3 (grand multiparous patients) were compared with those of the other groups. Results: The mean age of the patients in group 3 (grand multipara) was found to be significantly higher than those of the other groups (p0.05). The percentages of patients with the tumor stage 1A in the groups 1, 2 and 3 were found to be 75%, 64.2% and 83.3%, respectively. All of the grand multiparous patients (group 3) were found to have stage 1 tumor. Conclusion: In conclusion, grand multiparous patients were diagnosed at advanced age but their diseases were endometrioid type endometrial cancer at an early stage. The protective effect of pregnancies against endometrial cancer decreases at advanced age. The period of time after last birth may be a factor on the risk of endometrial cancer.

Anahtar Kelimeler

• Endometrial cancer, grand multiparity, nulliparity, pregnancy

Endometriyum kanserli grand multipar hastalarda tanı ve klinik bulguların değerlendirilmesi

Öz

Amaç: Bu çalışmanın amacı grand multipar, endometrium kanserli hastaların tanısal ve klinik özelliklerini diğer endometrial kanserli hastalar ile karşılaştırarak değerlendirmektir. Yöntemler: Kliniğimizde Ocak 2006-Ağustos 2012 tarihleri arasında endometrium kanseri nedeniyle opere edilen 34 hasta dahil edildi. Hastalar doğum sayısına göre üç gruba ayrıldı; Grup 1 (doğum yapmamış hastalar, n=8), Grup 2 (doğum sayıları 1\'den 4\'e kadar olan hastalar, n=14), Grup 3 (grand multipar hastalar, n=12). Grand multipar hastaların tanısal, klinik ve histopatolojik verileri diğer gruplardaki hastalar ile karşılaştırıldı. Bulgular: Grup 3 (grand multipar) hastaların yaş ortalaması diğer gruplara göre anlamlı yüksek bulundu (p0,05). Grup 1, 2 ve 3\' deki Evre 1A tümörlü hastaların oranlarının sırasıyla %75, %64,2 ve %83,3 olduğu bulundu. Ayrıca, bütün grand multipar hastaların evre 1 tümöre sahip oldukları bulunmuştur. Sonuç: Sonuç olarak, grand multipar hastaların tanıları daha geç yaşlarda konmakta, fakat erken evrede ve endometrioid tip endometrial kanser tanılarını almışlardır. Son doğumdan itibaren geçen süre endometrial kanser riski üzerine etkili bir faktör olabilir.

Anahtar Kelimeler

• Endometrium kanseri, grand multiparite, nulliparite, gebelik

Kaynakça

1. Boyle P, Ferlay J. Cancer incidence and mortality in Europe, 2004. Ann Oncol 2005;16:481-488.
2. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin 2010;60:277-300.
3. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127:2893-2917.
4. Turgut A, Ozler A, Sak ME, et al. Retrospective analysis of the patients with gynecological cancer: 11-Year Experi- ence. J Clin Exp Invest 2012;3:209-213.
5. Bokhman JV. Two pathogenetic types of endometrial carci- noma. Gynecol Oncol 1983;15:10-17.
6. Key TJ, Pike MC. The dose-effect relationship between «unopposed» oestrogens and endometrial mitotic rate: its central role in explaining and predicting endometrial cancer risk. Br J Cancer 1988;57:205-212.
7. Kvåle G, Heuch I, Ursin G. Reproductive factors and risk of cancer of the uterine corpus: a prospective study. Cancer Res 1988;48:6217-6221.
8. Pocobelli G, Doherty JA, Voigt LF, et al. Pregnancy history and risk of endometrial cancer. Epidemiology 2011;22:638- 645.

9. Hinkula M, Pukkala E, Kyyrönen P, et al. Grand multiparity and incidence of endometrial cancer: a population-based study in Finland. Int J Cancer 2002;98:912-915.
10. Solomons B. The dangerous multipara. Lancet 1934;II:8- 11.
11. White LN. An overview of screening and early detection of gynecologic malignancies. Cancer 15 1993;71:1400-1405.
12. Salvesen HB, Akslen LA. Molecular pathogenesis and prognostic factors in endometrial carcinoma. APMIS 2002;110:673-689.
13. Purdie DM, Green AC. Epidemiology of endometrial can- cer. Best Pract Res Clin Obstet Gynaecol 2001;15:341-354.
14. Henderson BE, Ross RK, Pike MC, et al. Endogenous hormones as a major factor in human cancer. Cancer Res 1982;42:3232-3239.
15. Albrektsen G, Heuch I, Tretli S, et al. Is the risk of cancer of the corpus uteri reduced by a recent pregnancy? A pro- spective study of 765,756 Norwegian women. Int J Cancer 1995;61:485-490.
16. Salvesen HB, Akslen LA, Albrektsen G, et al. Poorer sur- vival of nulliparous women with endometrial carcinoma. Cancer 1998;82:1328-1333.
17. Hachisuga T, Fukuda K, Hirakawa T, et al. The effect of nulliparity on survival in endometrial cancer at different ages. Gynecol Oncol 2001;82:122-126.
18. Lambe M, Wuu J, Weiderpass E, et al. Childbearing at older age and endometrial cancer risk (Sweden). Cancer Causes Control 1999;10:43-49.
19. Albrektsen G, Heuch I, Wik E, et al. Parity and time inter- val since childbirth influence survival in endometrial cancer patients. Int J Gynecol Cancer 2009;19:665-669.
20. Bevier M, Sundquist J, Hemminki K. Does the time interval between first and last birth influence the risk of endometrial and ovarian cancer? Eur J Cancer 2011;47:586-591.