Estrogen and combined hormone therapy for women after genital malignancies: a review

This review summarizes information regarding estrogen therapy (ET) and hormone therapy (HT) for women with endometrial cancer as well as other gynecologic malignancies. The cumulative experience from 4 case-control studies consists of 537 affected women. Of the 228 patients who received estrogen therapy, 3.5% developed recurrences as opposed to 16.5% among the 309 women receiving no therapy. Administration of ET at an early stage of disease is therefore appropriate if a few conditions are fulfilled. The impact of estrogen on other gynecologic malignancies is not as evident. As to ovarian cancer, the information on hormone employment is scantier and derives mainly from statistical analysis of data on healthy users of estrogen alone or combined with progestin. Several age-matched, case-control studies and 4 meta-analyses disclosed a higher rate, though not significant, of the later development of ovarian cancer among hormone users. Focusing on patients with disease, 2 trials conducted so far have failed to demonstrate any change in survival or mortality from ET or HT. It is agreed, however, that the histologic type of the tumor is an important factor to consider prior to the initiation of such therapy. The current literature permits ET in most cases of ovarian cancer, but further studies are needed to clearly delineate specific contraindications. Utilizing estrogen compounds has no bearing on risks of later developing squamous cell carcinoma of the cervix, or tubal, vulvar or vaginal cancer. Those conditions do not seem to contraindicate later employment of ET or HT. A previous history of cervical adenocarcinoma, however, definitely prohibits the use of these hormonal regimens.