| Tamoxifen ( TAM ) is a kind of non-steroidal and anti-estrogenmedication, synthesized by the British in the1960s, when as a contraceptivedrugs in clinical use。In 1977 by the United States Food and Drugs Authorityapproved for treatment of post-menopausal women whose breast cancer havetransfered。 In clinical certification for 15 years, it founds that the TAM canalso contain menopausal women oestrogenic receptors -positive breast cancer,the survival period of the extension without disease and reduce the incidence ofbreast cancer patients detained breast cancer. Now TAM as pre-menopausal andpost-menopausal women treatment of breast cancer endocrine preferred drugwithout considering its phased factors. In addition, the US National mammarygland and intestine tumors in surgical treatment projects also support theprevention of breast cancer as a means TAM be in the clinical application of theresults in health-positive women crowd barriers oestrogenic receptors reduce theincidence of breast cancer by 45%. As TAM increasingly in young patients, evenin long-term health of women and post-menopausal women using clinicalapplications in the area of gynaecological side effects, should give rise to clinicalattention. many scholars found TAM clinical research in the prevention ofrecurrence of breast cancer while women can lead to endometrial hyperplasia,polyp, or even endometrial cancer. Polyp is the most common disease. Theendometrial hyperplasia and endometrial cancer are similar to usually situation,but polyp it has led to is great, gland irregular expanding, cystoid hyperplasia andedema and fibrosis is its histology character. Clinical report for the largest polypis 13 x 6 x 7.5cm3 by gland muscle disease for taken TAM for eight years[10]. therelationship of The side effects of TAM to endometrium and taking TAM dose orthe length of time has taken no uniform opinion. Most scholars believe that theside effects of TAM is correlational to durial time and cumulative dose of thedrug close, has little to the medicine dose .About mechanism of TAM on endometrium, many scholars conductedvarious studies. On animal experiments and clinical trials ,Some scholars believethat TAM with anti-oestrogenic and oestrogenic characteristic, has double-sidednature,has the relation with the oestrogenic receptors. When oestrogenic level ishigh ,TAM makes the anti-oestrogenic action.So pre-menopausal patients are notbasically impact;on the contrary it makes the oestrogenic action, so it has thelarger impact on post-menopausal patients. However, after the clinical study,itfounds pre-menopausal patients have high incidence. Some scholars studied inthe molecular level。They think that TAM has carcinogenicity to induce Theoriginal cancer gene a high mutation rate of k-ras 12 codon inendometrium.Recent studie has been confirmed by yongfeng shang: TAM isnot only affect expression of oestrogenic relevant target gene ,but also regulatemuch gene expression such as PAX2 gene,which is the key in the endometrialcell hyperplasia. But it has not been reported that endometrial ultrastructure isinspected through elect-microscopy ,which is simple and visual observation ofthe effects of the drug on cell biology. Because the cell is the Pathologicalchange's foundation, it can be inferred from another perspective its rolemechanism and dangerous period.This study ,through clinical follow-up and elect-microscopy,is to evaluatethe effect of tam on endometrium, discuss the action of tam on endometriumand forecast the dange?rous period of endometrial Pathological changes inducedby tam. Methods: To Choice oestrogenic receptors -positive 31 cases underTAM , The gynaecological examinations were taken before taking tam,endometrium and ovary are no pathological changes. Every six months to taketransvaginal ultransonographic inspection, endometrial biopsy or historoscopicwith sonography inspection and biopsy. Compare endometrial changes of all thetime period. And the control: choice 26 cases breast cancer patients withouttaking tam in the same period as the control to compare the incidence ofendometrial ailments. Endometrial biopsy is done in 12 cases by hysteroscopyinspection, ultrastructure is observed by elect-microscopy, compared with thenormal endometrium.Results: Taking tamoxifen (TAM) for more than 6 monthsis appeared incrassation of endometrial thickness ,which has statistics significantcompared to medication ahead and six months.Taking TAM for six months andtwelve months ,endometrium has no pathological changes;Taking it for more thantwelve months appears endometrial hyperplasia six cases;endometrial polyp 2cases. TAM group ailments rate 28.8% (8/28) is clearly higher than the control3.85% (1/26),the comparison of two group has statistical significance. Aftertaking Tam endometrial ultrastructure indicates Taking tam for 6months ,endometrial ultrastructure is simlar to normal endometrial .But itmainly appeas the amount of stroma cell is more,the size is not the same,mitochondria swelling, ridges fractured, edema for 12 months. Taking it foreighteen months ,it appears more lysosomes in gland cell, less glycogen ,morestroma cells, nuclear contraction and chromatin cohesion,less fibre ,cell gapincreased, edema.conclusions:1.Taking tam for long term can inducehyperplasia , polyp.2. Ultrastructure observation speculates thattamoxifen can lead to stroma hyperplasia and edema,which is the baseof endometrium hyperplasia.3. taking tam smallest dose (20mg/d),thedangerous period is after a year, the patients are examined in everysix months to take TAM for more than one year ,followed by histeroscopy+ ultransonography. If the patients appear endometrial unusual echo,endometrial thickness increasing and irregular uterine bleeding ,itis necessary to examined by hysteroscopy.
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