Talk:Endometrial cancer

In premenopausal women who are not on birth control, the cause of endometrial cancer is overwhelmingly most likely to be lack of periods -- either significantly fewer periods than normal or completely absent periods. This causes a buildup of the uterine lining (endometrium) over time, and is known as endometrial hyperplasia. You first need to have endometrial hyperplasia to get endometrial cancer, yet most cases of endometrial hyperplasia will not become cancerous. Is this correct? 2601:98A:480:C080:289C:A68F:6403:3EFF (talk) 06:55, 29 April 2020 (UTC)

Refs over one line or many
Most people prefer them over one line thus I would request that User:Headbomb revert his edits here  Doc James  (talk · contribs · email) (if I write on your page reply on mine) 02:42, 28 July 2014 (UTC)

Belated points

 * The Sasa et al 2011 BMJ review says "Two investigations are mandatory in women with suspected endometrial cancer: a transvaginal ultrasound scan and an endometrial biopsy." Article currently says "Transvaginal ultrasound to examine the endometrial thickness in women with postmenopausal bleeding is increasingly being used to aid in the diagnosis of endometrial cancer." which is rather different. If this a national difference between guidelines we should indicate so.
 * Yep, that appears to be a trans-Atlantic thing, since Hoffman et al. is an American textbook (as far as I can tell). I've clarified the difference in the text now. Keilana&#124;Parlez ici 00:08, 20 August 2014 (UTC)
 * Done Wiki CRUK John (talk) 10:59, 21 August 2014 (UTC)
 * Sasa et al sets out a trans-Atlantic difference re surgery. Article: "Lymphadenectomy, or removal of pelvic and para-aortic lymph nodes, is performed for tumors of grade II or above." Sasa (in FIGO stage 1): "The subject of pelvic lymphadenectomy is disputed across the Atlantic. In the UK, pelvic lymphadenectomy is not routinely performed along with total abdominal hysterectomy and bilateral salpingo-oophorectomy in women with stage I disease. This stance is supported by a Cochrane Collaboration review, ... In the United States, however, the opposite applies and pelvic lymphadenectomy is routinely performed alongside total abdominal hysterectomy and bilateral salpingo-oophorectomy. A large retrospective observational study ....". Is Sasa out of date? Maybe expand coverage somewhat?
 * I think part of the issue here is that that particular sentence is referring to the histologic grade of the tumor instead of the stage. I've added a sentence about the trans-Atlantic difference between pelvic lymphadenectomy as it relates to staging, in any case. Does that look okay? Keilana&#124;Parlez ici 00:14, 20 August 2014 (UTC)
 * Oops, sorry, mixed the 2 up, not for the first time. Your changes cover this point & the last point nicely. Wiki CRUK John (talk) 11:02, 21 August 2014 (UTC)


 * The ESMO Guidelines (Colombo, Preti et al) apparently were revised in 2013, see here, beyond the 2011 version now cited. Don't know what changes.
 * Hey, so I incorporated all the new information from the 2013 version, but there were two pieces of information included in the previous one that weren't in the latest version. Do you think they can stay, or should I remove them? Thanks, Keilana&#124;Parlez ici 02:44, 25 August 2014 (UTC)


 * I could rewrite the epidemiology section from the latest World Cancer Report 2014, which has more info, but I'm reluctance to mix and match with what is there - eg the WCR uses "North America" not US, and so on.
 * Hi again, I incorporated all this information. It's not terribly well written yet but that will happen soon. :) Thanks for all these comments! Keilana&#124;Parlez ici 01:53, 26 August 2014 (UTC)
 * More later, plus I hope soon by others here (these are just me). Wiki CRUK John (talk) 14:26, 19 August 2014 (UTC)

Lead image
The "c blausen" needs to be removed from the image Doc James  (talk · contribs · email) (if I write on your page reply on mine) 14:40, 24 August 2014 (UTC)
 * Unfortunately, I have approximately 0 photoshop skills.... I could give it a shot but it would probably involve MS Paint... Keilana&#124;Parlez ici 15:33, 24 August 2014 (UTC)
 * My dad loves doing this sort of stuff. Let me see if I can convince him. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 21:31, 24 August 2014 (UTC)
 * I managed to do it with paint. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 09:50, 25 August 2014 (UTC)
 * You are fantastic! Keilana&#124;Parlez ici 13:56, 25 August 2014 (UTC)

CRUK review
I have had the feedback on this now, and have a marked-up print out. In general it was thought pretty good, and these are relatively minor points. I think I'll just make the smaller changes re wording etc myself now, but do say if there are any you have problems with. Then I'll list more complex things here. Wiki CRUK John (talk) 15:54, 29 August 2014 (UTC)
 * Ok, done that here -
 * "Risk factors" - was thought too short - [me] I think this means not enough on age, but this is below in the epidemiology section, as we usually do it. I wonder if it might be better to move it up to here though -seems more logical.
 * Hmm, I've heard both sides - epidemiology AND risk factors. I don't know what the standard is and I don't want to be repetitive, do you have an idea for how to deal with that?
 * "A 1-2 year course of tamoxifen approximately doubles the risk of endometrial cancer, and a 5-year course of therapy quadruples that risk" - true but thought a bit scary for tamoxifen-takers - basic risk is fairly low. Ideally start this section with what overall risk is.
 * Done - lifetime risk of 2-3% is now the lead sentence.
 * Pathophysiology was not checked, nor I think Epidemiology
 * "Diagnosis" - mention blood tests for CA125"
 * Done.
 * "Add-on therapy" (is this a common term?) Take Chemo/radio etc bits a bit slower to make the different options rather clearer: single/combined, before/after. Maybe divide up the section.
 * It's technically called "adjuvant therapy" but we tried to simplify the language a little. I've added both names and cleaned up the pacing a little. Better?
 * "Mutations in mismatch repair genes can lead to resistance against platins." - explain this means chemo won't work for those with certain genetics.
 * Done.
 * "high-risk" & "early-stage" could be explained
 * I glossed the first instances of both, should I explain it every time?
 * Para beginning "Hormonal therapy is" reads as a bit contradictory, though factually correct: "most cases" vs. "25%". Maybe reword.
 * I've beat on it a little, and I think it sucks less.
 * PARP inhibitors are new, and not often used in UK.
 * Yeah they are, I've added some more information from recent reviews.
 * "Research" could do with expanding - there are other things mentioned on the CRUK page.
 * I've incorporated all of that! Thanks for pointing me there!
 * That's it. Wiki CRUK John (talk) 16:31, 29 August 2014 (UTC)
 * Technically term is "adjunctive therapy". I have heard it referred to as "add on therapy" Doc James  (talk · contribs · email) (if I write on your page reply on mine) 11:55, 30 August 2014 (UTC)
 * Thank you SO MUCH for this review! I could not be more grateful. Keilana&#124;Parlez ici 23:25, 31 August 2014 (UTC)

Endometrial cancer for Today's Featured Article
I've set-up Endometrial cancer as a blurb for the Today's Featured Article requests process.

You can see it at Today's featured article/requests/Endometrial cancer.

However, as I myself have nominated a bunch of other articles lately, I won't actually transclude it at Today's featured article/requests.

If anyone else wishes to do so, they can follow the instructions at Today's featured article/requests, and then a discussion will start as to the article's consideration for the Main Page.

Thank you,

&mdash; Cirt (talk) 01:50, 19 November 2014 (UTC)

Sourcing
I don't want to litter an FA with tags, but book sources need page numbers. This source is cited dozens of times, with no page nos.
 * Hoffman, BL; Schorge, JO; Schaffer, JI; Halvorson, LM; Bradshaw, KD; Cunningham, FG, eds. (2012). "Endometrial Cancer". Williams Gynecology (2nd ed.). McGraw-Hill. ISBN 978-0-07-171672-7.
 * I mentioned this on the other page but I had been using an electronic copy that doesn't have page numbers; I just bought the hard copy and will be adding pages this afternoon (final paper due today, after that's done). Keilana&#124;Parlez ici 16:17, 8 December 2014 (UTC)
 * Just to clarify, I know this goes up in like 8 hours and I will have page numbers before then. Paper is due in an hour and a half and I need to go finish that. I'll check back then. Keilana&#124;Parlez ici 16:30, 8 December 2014 (UTC)
 * I am not suggesting you must do it before TFA (just concerned generally that things like this are getting though FAC). Please focus on your paper first!  Sandy Georgia  (Talk) 17:24, 8 December 2014 (UTC)
 * Paper is done (8 whole minutes before the deadline!) and no more exams today so I do have time to get this finished. :) Keilana&#124;Parlez ici 18:12, 8 December 2014 (UTC)

This citation (and other web sources) is incomplete (date, volume, accessdate, etc) Sandy Georgia (Talk) 19:31, 6 December 2014 (UTC)
 * Committee on Health Care for Underserved Women (December 2011). "Health Care for Transgender Individuals". American Committee for Obstetrics and Gynecology.
 * It's got a date (December 2011) and I hadn't realized it had a PMID. Should be better now. Keilana&#124;Parlez ici 16:17, 8 December 2014 (UTC)

Prose
Not sure why white is lower case, Black upper, and should the term African American be used instead? Sandy Georgia (Talk) 20:02, 6 December 2014 (UTC)
 * In the United States, white women have a higher survival rate than Black women, who tend to develop more aggressive forms of the disease.
 * White was a typo, and since the source said "Black", I'm hesitant to assume African-American women only; that could include Caribbean-American women etc. They didn't specify what constituted "Black". Keilana&#124;Parlez ici 16:19, 8 December 2014 (UTC)

LEAD
See Wikipedia talk:Today's featured article/December 9, 2014 Sandy Georgia  (Talk) 15:29, 8 December 2014 (UTC)
 * Working on the blurb now. I'd add this query about the fourth para of the lead:
 * " " Is there a missing word ("one of the most common cancers) or should it be "the most common cancer"? BencherliteTalk 16:22, 8 December 2014 (UTC)
 * That's a typo, it's the most common cancer. Keilana&#124;Parlez ici 16:28, 8 December 2014 (UTC)

Are we done here now? If so, please feel free to hat/hab? Sandy Georgia (Talk) 19:09, 8 December 2014 (UTC)

Birth control clarification
The lead says: I cannot find that in the first citation given, and the second is not an online source. The body of the article says: And the sources given for this section are different than those used in the lead. One says: This stands out to me because combo therapy is controversial; some ob/gyns and endocrinologists give progesterone and estrogen separately. This needs to be sorted. Sandy Georgia (Talk) 16:00, 8 December 2014 (UTC)
 * Whereas taking estrogen alone increases the risk of endometrial cancer, taking both estrogen and progesterone in combination, as in most birth control pills, decreases the risk.
 * Progestin is present in the combined oral contraceptive pill and the hormonal intrauterine device (IUD). Combined oral contraceptives reduce risk more the longer they are taken: by 56% after 4 years, 67% after 8 years, and 72% after 12 years. This risk reduction continues for at least 15 years after contraceptive use has been stopped.
 * Risk factors include postmenopausal estrogen therapy, ... and nothing about 15 years, and nothing about combined vs. solo therapy, and nothing with those risk numbers at all.  (That is, the text doesn't seem to be cited, doesn't seem to agree with the lead).
 * So in the NCI PDQ summary, it says this: "Based on solid evidence, at least 1 year’s use of oral contraceptives containing estrogen and progesterone decreases endometrial cancer risk, proportionate to duration of use. This benefit lasts at least 15 years after cessation.[1,2] Magnitude of Effect: Use of oral contraceptives for 4 years reduced risk by 56%, 8 years by 67%, and 12 years by 72%.". That's where the 15 years is coming from and it seems to be cited to the correct page in the article. And since it says "containing estrogen and progesterone", I think that clarifies the combined therapy. Combo therapy is not really controversial, you can give separate estrogen and progesterone pills or have them in the same pill, what matters for endometrial cancer is whether the estrogen therapy is unopposed by progesterone or not. I think we covered the "most birth control pills" thing elsewhere. Keilana&#124;Parlez ici 16:26, 8 December 2014 (UTC)
 * OK, that info clears it up, but ... I'm not getting that text at all from the link given in the citation. I have now found it, and it looks like you meant to link to page 2 ??    Sandy Georgia  (Talk) 17:31, 8 December 2014 (UTC)
 * Yep, definitely meant to link it to page 2. Should be sorted now. Keilana&#124;Parlez ici 18:10, 8 December 2014 (UTC)

Another (related) matter
Probably best taken up at WT:MED, but I don't know why the FA menstrual cycle is linked nowhere in this article, relative to the c-class menstruation, which is linked. Sandy Georgia (Talk) 18:03, 8 December 2014 (UTC)
 * Never mind, found it and fixed the link to avoid redirect. (There is a toolbox on FACs to check for redirects.)  Sandy Georgia  (Talk) 18:17, 8 December 2014 (UTC)
 * Could you show me that tool? I'm not familiar with it and it sounds super useful. Keilana&#124;Parlez ici 18:43, 8 December 2014 (UTC)
 * I've installed them at the top of this page (you can use them on any article), but I suspect that all of the tools in the box aren't working as they used to. Sandy Georgia  (Talk) 19:08, 8 December 2014 (UTC)
 * That's nifty! It's not showing any more weird redirects, just what redirects to this article. Thank you! Keilana&#124;Parlez ici 19:23, 8 December 2014 (UTC)

Endometriosis
This is at endometriosis: Is it worthy of mention here? Sandy Georgia (Talk) 19:55, 6 December 2014 (UTC)
 * Despite similarities in their name and location, endometriosis bears no relationship to endometrial cancer.
 * I think this is adequately addressed with the section on endometrial hyperplasia but I wouldn't be opposed to a hatnote or something. Keilana&#124;Parlez ici 16:02, 8 December 2014 (UTC)

Should we choose a less disturbing image for the Main Page?
I was somewhat nauseated by the appearance of this bloody medical photograph, which appears as the first image on the main page today. Should we display a different image from this article on the Main Page? Jarble (talk) 06:17, 9 December 2014 (UTC)
 * I would choose a micrograph. Doc James  (talk · contribs · email) 06:43, 9 December 2014 (UTC)
 * I don't really see an issue with the current picture. -- Guerillero &#124;  My Talk  07:02, 9 December 2014 (UTC)
 * Accuracy is great, but I agree - maybe a little too real — Preceding unsigned comment added by 74.88.35.154 (talk) 08:07, 9 December 2014 (UTC)
 * I believe in drawing people to an article, not driving them away with disturbing imagery. I'm a cancer survivor so I know how ugly this disease can be but many people are going to be unsettled by the bloody image and it seems a poor choice.Rob Banzai (talk) 19:11, 9 December 2014 (UTC)
 * Yes we should have done for the main age, and probably should still change it. Apart from anything else, like most such images it doesn't really convey anything much to those not medically trained. I don't believe in micrographs as lead pics either, for the same reason; these only convey anything to pathologists etc, and we rarely explain them at all. In a case like this a diagram showing where the endometrium is (not exactly common knowledge) is usually the best choice. But I have some potential COI, as many of such images are CRUK releases, though far from all. Wiki CRUK John (talk) 14:05, 10 December 2014 (UTC)
 * Oh, I forgot we have a very decent Blausen diagram as the actual lead pic in the article. It was a mistake not to use that or similar on the TFA blub. Wiki CRUK John (talk) 14:11, 10 December 2014 (UTC)

Moved this here
"Neither endometrial biopsy nor dilation and curettage is sufficiently accurate to rule out endometrial carcinoma. "

I have read parts of the paper and unable to find the bit that supports this? Doc James (talk · contribs · email) 03:01, 17 March 2015 (UTC)
 * I don't remember adding this, since I don't format citations like that. I think whoever added that was looking at: "Several methods of endometrial sampling are used in the different studies and over time. Although some authors have reported similar diagnostic capability of different techniques,47 other authors found that the risk of cancer for women who had a biopsy was different to those who had a dilation and curettage 14,48 or hysteroscopic resection.", "In this study, patients with AEH who had a biopsy rather than hysterectomy showed a benign outcome." Williams Gyn says "As an alternative to sonography, Pipelle office biopsy or outpatient dilatation and curettage (D&C) may be initially selected for evaluation of abnormal bleeding (Merisio, 2005). Grossly, hyperplastic endometrium is not distinctive, and thus, direct visual identification using hysteroscopy is inaccurate (Garuti, 2006)." and "Office Pipelle biopsy is preferred for the initial evaluation of women with bleeding suspicious for malignancy (Feldman, 1993). However, if sampling techniques fail to provide sufficient diagnostic information or if abnormal bleeding persists, D&C may be required to clarify the diagnosis (Gordon, 1999)."


 * Since the source given doesn't really support the statement (I read the whole study, very interesting), as it really just says that rates of carcinoma found on hysterectomy after a biopsy finds abnormal endometrial hyperplasia, I've removed that sentence. Thanks for pointing this out! Keilana&#124;Parlez ici 18:18, 17 March 2015 (UTC)
 * Yes was added here Waiting for User:Akram1988 to justify the addition.  Doc James  (talk · contribs · email)
 * User:Akram1988 the ref says that in those with a precancerous lesion these do not exclude cancer. It does not say they do not exclude cancer in those with no precancerous lesion. Also please use secondary sources. Doc James  (talk · contribs · email) 01:16, 18 March 2015 (UTC)

Thombocytosis and hyperglycaemia
The new NICE guideline for suspected cancer (http://www.nice.org.uk/guidance/NG12, page 160-166 of the full guideline) discusses warning signs for endometrial cancer and when to perform gynaecological ultrasound. In women over 55 USS is suggested in those with unexplained vaginal discharge (when presenting de novo or if associated with thrombocytosis or hyperglycaemia) or those with haematuria (associated with either anaemia or thrombocytosis or hyperglycaemia). This is largely based on 10.3399/bjgp13X671632 which itself is a primary source. Worth discussing the relevance of these features? JFW &#124; T@lk  14:03, 24 December 2015 (UTC)

Lancet seminar
10.1016/S0140-6736(15)00130-0 Might be useful to match this with the current content. JFW &#124; T@lk  13:10, 11 March 2016 (UTC)

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