ABSTRACT
The preponderance of data support the benefits of HRT in estrogen-deprived and menopausal women to reduce the risks of osteoporosis and cardiovascular disease and to enhance quality of life and life expectancy. Controversies exist with regards to the risk-benefit ratio in women with a history of estrogen-dependent gynecologic tumors or breast cancer. Until these issues are resolved, physicians must carefully weigh, on an individual basis for each patient, the potential risks against the known benefits. Women should be counseled regarding the benefits of exercise, weight control, breast feeding, and cessation of cigarette smoking or excessive alcohol to reduce their risks of cancer, cardiac disease, and/or osteoporosis. HRT is not a panacea for an unhealthy lifestyle. When ERT is contraindicated, viable alternatives to retard bone loss and/or control vasomotor symptoms include calcium supplementation and progestin therapy. The role of tamoxifen as an alternative HRT in women at increased risk for breast cancer development is currently under investigation.
Subject(s)
Estrogen Replacement Therapy , Menopause , Breast Neoplasms/chemically induced , Cardiovascular Diseases/prevention & control , Endometrial Neoplasms/chemically induced , Estrogen Replacement Therapy/adverse effects , Female , Humans , Middle Aged , Osteoporosis, Postmenopausal/prevention & control , Risk FactorsABSTRACT
BACKGROUND: Germ cell tumors, the most common ovarian malignancies in females under the age of 21, are rare in older women. We report an unusual case of a mixed embryonal carcinoma and endodermal sinus germ cell tumor in a perimenopausal patient and review the differential diagnosis and management of these malignancies with respect to age. CASE: A 53-year-old woman complaining of irregular menses and pelvic pain was found to have a large pelvic mass and a positive pregnancy test. Subsequent investigation revealed a large left adnexal mass, and an elevated beta-HCG and alpha-AFP. At laparotomy, a mixed germ cell tumor was found. The patient was treated with multiagent chemotherapy and currently is without evidence of disease. CONCLUSION: Although rare, the diagnosis of germ cell tumor should be considered in older women presenting with a large pelvic mass. The treatment and prognosis is similar regardless of age, except that reproductive-sparing surgery is not a priority in the older patient.
Subject(s)
Carcinoma, Embryonal/pathology , Endodermal Sinus Tumor/pathology , Germinoma/pathology , Neoplasms, Multiple Primary , Ovarian Neoplasms/pathology , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bleomycin/therapeutic use , Carcinoma, Embryonal/drug therapy , Carcinoma, Embryonal/surgery , Cisplatin/therapeutic use , Diagnosis, Differential , Endodermal Sinus Tumor/drug therapy , Endodermal Sinus Tumor/surgery , Etoposide/therapeutic use , Female , Germinoma/drug therapy , Germinoma/surgery , Humans , Middle Aged , Ovarian Neoplasms/drug therapy , Ovarian Neoplasms/surgeryABSTRACT
The decline and eventual cessation of estrogen production by the ovary at menopause are reflected physiologically in tissues with estrogen receptors. The rate of decline of hormones is quite variable and often relates to symptoms experienced. At menopause women still have one third of their life expectancy ahead of them. The physician must determine which symptoms are aging, physiologic changes resulting from estrogen deprivation and which may herald more serious pathology in need of diagnosis and treatment. The knowledgeable physician can give good explanation, which is sometimes as beneficial as medications. Hormone replacement therapy may improve physiologic function of some tissues and relieve symptoms. When hormones are given for clear indications in as safe a method as possible and with adequate monitoring, the woman will have her symptoms relieved and will be grateful for her sense of well-being and ability to enjoy life.
