The effect of ART on gynecological cancer: Report of our experiences and literature review
Mojgan karimi -zarchi1*, Mitra rouhi2,Alime H. Abdolahi3
1-Corespondance:Associated professor, Gynecology Oncology fellowship, Gynecology Oncology Department, Shahid Sadoughi University of Medical
Science. Correspondence Address: Iran, 14194,Yazd, Safaieh, Shahid Ghandi Blv. Shahid Sadoughi Hospital, 2 flow, Surgical Oncology Department
2,3Medical Student Scientific Association, Faculty of Medical Sciences, Islamic Azad University, Yazd Branch, Yazd, Iran.
Phone number: #983518224000-9,Fax: #983518224100,Email:drkarimi2001@yahoo.com
Conclusion:
Introduction:
Infertility is being as an important and common problem in couples that needs
to assisted reproductive technology (ART) or the other drug therapy.
Infertility has been known as a risk factor for ovarian cancer, breast
cancer and endometrial cancer but there is a question about the
relationship of these cancers to infertility itself or drugs and methods of
infertility treatment.
Material and method:
We evaluated all of risk factors in patients with breast cancer, ovarian cancer
and endometrial cancers who referred to Gynecological Oncology
Clinic in Shahid Sadoughi Hospital within 2002-2012 .In a retrograde
study, we investigated the history of primary infertility and ART before
diagnosis of cancers in patients .
Result:
We registered 92 patients with endometrial cancer,84 patients with advanced
epithelial ovarian cancer and 113 patients with breast cancer. There was
infertility history in 39.1% of endometrial cancer who were obese
(BMI>30)and 18.8% of patients with normal body mass
index(BMI=25-29). ART was founded in 7.3% of all patients with
endometrial cancer. Also in patients with epithelial ovarian cancer,
female infertility has been diagnosed in 28.4% and ART in
14.1%.Clomiphen therapy with or without HCG and HMG was the
most common drugs which was used for patients with ovarian cancer.
In all patients with breast cancer,there was infertility in 16.5% and
ART was diagnosed in 7.3%.
Although infertility was diagnosed as an important and fairly common risk
factor in endometrial,ovarian and breast cancer, but some other factors
are more important. Age,body mass index and cause of infertility are
also important. Finding the association of ART to gynecological
cancers need some other long cohort studies which follow the infertile
women who get the ART or drug therapy for over 15-20 years. The
other studies in this field cannot answer to our question about
increasing gynecological cancer due to ART. We think BMI and age
are co-factors to cancers which should added to infertility or ART. We
had better discus this relationship to the partners and have a
multidisciplinary management for obese infertile women who had had
polycystic ovarian syndrome or age more than 35 years. Breast cancer
screening should be investigate in infertile women after 35 years
because breast is the most common site of primary cancers which send
metastasis to ovaries.
References:
1-Nadereh Behtash, Mojgan Karimi Zarchi , Mitra Modares Gilani , Fatemeh
Ghaemmaghami, Azamsadat Mousavi,and Fahimeh Ghotbizadeh.
Ovarian carcinoma associated with pregnancy: A clinicopathologic
analysis of 23 cases and review of the literature. BMC Pregnancy
Childbirth. 2008; 8: 3.
2-Mojgan Karimi Zarchi1, Azamsadat Mousavi, Mitra Modares Gilani, Esmat
Barooti, Omid Amini Rad, Fatemeh Ghaemmaghami, Soraya Teimoori,
Nadereh Behtas. Fertility Sparing Treatments in Young Patients with
Gynecological Cancers: Iranian Experience and Literature Review.
Asian Pacific Journal of Cancer Prevention, Vol 12, 2011.
A Comparison of the effect of levonorgestrel IUD with oral medroxyprogesterone acetate on abnormal uterine
bleeding with simple endometrial hyperplasia and fertility preservation
Mojgan Karimi-Zarchi1,c , Razie Dehghani-Firoozabadi2,Afsarosadat Tabatabaie3,Ziba Dehghani-Firoozabadi4, Soraya Teimoori5,Zohreh Chiti6,Atefe
Dehghani7
1,c:Correspondence,
Associate professor, Gynecology Oncology fellowship, Gynecology Oncology Department,Reproductive research center, Shahid Sadoughi University of
Medical Science,Yazd,Iran.Address: Gynecology Oncology Department, Shahid Sadoughi Hospital, Shahid Ghandi BLV, Yazd, 14194, Iran; Phone: #98-351-8224000-9,Fax:
#98-351-8224100,Email:drkarimi2001@yahoo.com
Objective :
Results :
Endometrial hyperplasia is important clinically, because it can lead to abnormal
uterine bleeding (AUB) which itself can precede to endometrial cancer.
Endometrial carcinoma is the most common malignancy of the female
genital tract, occurring about 75%-85% in younger, perimenopousal women
as hyperplasic endometrial. The treatment is hysterectomy or hormone
therapy with progesterone. The aim of this study was, therefore, to compare
the effect of levonorgestrel IUD (Mirena) with medroxyprogesterone acetate
on simple endometrial hyperplasia for fertility preservation.
Our findings showed the significant differences in the treatment of simple
hyperplasia between two groups (levonorgestrel IUD group vs. MPA
group) (P<0.047). Recovery of AUB in the group of Mirena was enhanced
(P<0.047). Endometrial thickness was reduced in both groups (P<0.001),
but reduction of endometrial in Mirena group was even more. Also, Mirena
was tolerated more than MPA. Side effects of MPA was more and reached
significance (P<0.003).The rate of satisfactory with Mirena was higher
than medroxyprogesterone acetate and reached significance (P<0.048).
Material and Methods :
Conclusion :
40 women in reproductive age(22-47) with AUB that their endometrial biopsies
reports were simple hyperplasia were enrolled in this study and then
randomly divided into two groups. All patients presented with designed
special checklist which was filled with satisfaction. Complete history and
physical examination especially BP, BMI, breast examination, bimanual
vaginal examination and trans vaginal sonography (to measure the thickness
of endometrial and exclude the other pathologic lesions) were performed. In
first group, treatment was performed with medroxyprogestron (20mg/daily)
for 10 days and in other group Levonorgestrel IUD was prescribed. After 3
months, Trans vaginal sonography and biopsy of endometrium were done.
Therefore; status of AUB and side effects of two methods along with the rate
of satisfactory were evaluated.
The results of this study show that levonorgestrel IUD is more effective than
MPA in treatment of simple endometrial hyperplasia and can be helpful in
young women who want to preserve their fertilities.
References
1-Baron YM, Craus J, Agius RC et al. Synergistic effect on the treatment of
menorrhagia by endometrial biopsy followed by contemporaneous
insertion of the levonorgestrel intrauterine system .Gynecol Endocrinol.
2012 Feb 4. [Epub ahead of print]
2- Gemzell-Danielsson K, Schellschmidt I, Apter D. A randomized, phase II
study describing the efficacy, bleeding profile, and safety of two low-dose
levonorgestrel-releasing intrauterine contraceptive systems and Mirena.
Fertil Steril. 2012 Mar;97(3):616-22 .