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Abstract
Endometrial carcinoma is the most common malignancy of the female genital tract in the developed countries. It is predominantly a disease of obese, postmenopausal women of low parity, although an increasing proportion of younger patients with endometrial cancer have been reported. Over the last few decades, age-standardized incidence rates have risen in most countries and in urban populations. Developing countries and Japan have incidence rates 4 to 5 times lower than western industrialized nations, with the lowest rates being in India and south Asia. Endometrial cancer is divided into two subtypes: Type (1)is of endometrial of origin and estrogen plays an important role in this class of malignancy whereas type (II) endometrial carcinoma is represented largely by serus and clear cell adenocarcinoma. About 70-80%of adenocarcinoma are detected at early stage and consequently the clinical outcome after treatment is usually favorable. However, a significant number of patients will later develop local recurrence and distant metastasis, additionally tumor identified at late stages are associated with high level of morbidity and mortality. At present, there are no early detection tests for endometrial carcinoma in women without symptoms who are at average endometrial cancer risk.
Only approximately 50% of women with endometrial cancer have malignant cells on a Papanikolaou (Pap) smear. However, compared with patients who have normal cervical cytological findings, patients with suspicious or malignant cells are more likely to have deeper myometrial invasion, higher tumor grade, positive peritoneal cytological findings, and a more advanced stage of disease.
There is a strong association between the thickness of the endometrial strip and endometrial disease, with normal endometrium being usually less than 5 mm thick. One indication for this screening technique would be postmenopausal women who are receiving unopposed estrogen, Tamoxifen increases the risk of endometrial cancer twofold to threefold and produces a sonographically unique picture of an irregularly echogenic endometrium that is attributed to cystic glandular dilatation, stromal edema, and edema and hyperplasia of the adjacent myometrium.
Prolactin is a 23 kD protein that has a dual function – as a circulating hormone and as a cytokine. PRL is reportedly involved in more than 300 separate functions including development of the mammary gland, lactation, implantation and pregnancy, angiogenesis, and regulation of immune function. PRL is secreted by the pituitary gland and by multiple non-pituitary sites including human ovarian follicular cells, decidualized stromal cells of the human endometrium, and normal peripheral blood lymphocytes. The synthesis of extrapituitary PRLis driven by a different promoter than its pituitary counterpart although the amino acid structure of pituitary and extrapituitary PRL appears to be identical.
PRLis a single chain protein closely related to growth hormone and is the strongest discriminative biomarker for endometrial cancer with high diagnostic power for early stage disease, although previous case reports suggested that PRL may be an endometrial tumor marker for recurrent disease
Most of PRL comes from the pituitary gland, but some stromal cells of endometrium produce PRL during secretory phase, as well. Significantly elevated levels of PRL in endometrial cancer could be due to increased PRL secretion by stromal