Substantiated approaches to the diagnosis and treatment of tamoxifen-induced endometrial conditions in patients with breast cancer

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Abstract

Currently, tamoxifen is the gold standard in the treatment of hormone receptor-positive breast cancer, which reduces recurrent tumor risk by more than 40%. Tamoxifen, which belongs to selective estrogen receptor modulators, can cause endometrial changes in women of different age groups and increase the risk of hyperplasia and endometrial cancer by several times. In clinical practice, the occurrence of various endometrial alterations during tamoxifen treatment often leads to groundless drug withdrawal. Oncology, gynecology and radiology community knowledge related to optimal methods and criteria for diagnosing different tamoxifen-induced endometrial conditions, as well as in choosing the optimal treatment tactics, will be instrumental in the unified and correct approach to managing patients with hormone receptor-positive breast cancer and maintaining tamoxifen therapy due to its high effectiveness.

About the authors

Anna E. Protasova

Saint Petersburg State University

Author for correspondence.
Email: protasova1966@yandex.ru

MD, PhD, DSci (Medicine), Professor. The Department of Oncology, Medical Faculty

Russian Federation, Saint Petersburg

Irina A. Solntseva

North-Western State Medical University named after I.I. Mechnikov

Email: tsypurdeevan@mail.ru

MD, PhD, Associate Professor. The Department of Radiology and Radiotherapy

Russian Federation, Saint Petersburg

Anna A. Tsypurdeyeva

Saint Petersburg State University

Email: tsypurdeevan@mail.ru

MD, PhD, Associate Professor. The Department of Obstetrics, Gynecology, and Reproductive Sciences, Medical Faculty

Russian Federation, Saint Petersburg

Tatyana Yu. Semiglazova

N.N. Petrov National Medical Research Center of Oncology

Email: tsypurdeevan@mail.ru

MD, PhD, DSci (Medicine), Leading Researcher, the Head of the Department of Rehabilitation, the Head of the Department of Innovative Methods of Therapeutic Oncology and Rehabilitation

Russian Federation, Saint Petersburg

Marina B. Stenina

N.N. Blokhin National Medical Research Center of Oncology

Email: tsypurdeevan@mail.ru

MD, PhD, DSci (Medicine), Leading Researcher. The Department of Clinical Pharmacology and Chemotherapy

Russian Federation, Saint Petersburg

Svetlana V. Yureneva

National Medical Research Center of Obstetrics, Gynecology, and Perinatology named after Academician V.I. Kulakov

Email: tsypurdeevan@mail.ru

MD, PhD, DSci (Medicine), Professor, Leading Researcher. The Department of Gynecological Endocrinology

Russian Federation, Saint Petersburg

Oksana V. Yakushevskaya

National Medical Research Center of Obstetrics, Gynecology, and Perinatology named after Academician V.I. Kulakov

Email: tsypurdeevan@mail.ru

MD, PhD, Researcher. The Department of Gynecological Endocrinology

Russian Federation, Saint Petersburg

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2. Fig. 1. Patient N., 9 years postmenopausal, after 3 years 5 months of Tamoxifen therapy. Endometrial thickness = 10 mm. The structure of the endometrium is hyperechogenic, with slit-like inclusion cysts. Endometrial tissue is avascular. Subendometrial cysts are visualized. The endometrial-myometrial border is blurred (cystic endometrial atrophy)

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3. Fig. 2. Patient V., 5 years postmenopausal, after 3 years 8 months of Tamoxifen therapy. Endometrial thickness = 10 mm. Endometrial tissue is avascular (colour Doppler imaging) and soft (elastography). Cystic endometrial atrophy

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4. Fig. 3. Patient K., 8 years postmenopausal, after 5 years of Tamoxifen therapy. Endometrial thickness is increased to 18 mm

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5. Fig. 4. 5 years postmenopausal, after 5 years of Tamoxifen therapy. Bleeding from the genital tract. Endometrial thickness is increased to 39 mm. Invasion of the myometrium. Endometrial cancer (morphology study)

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6. Fig. 5. After 5 years of Tamoxifen therapy. In the uterine cavity, an oval shaped hyperechoic lesion with clear contours, a thin halo and a feeding vessel within the base along its front wall (endometrial polyp) is visualized

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7. Fig. 6. Patient D. aged 67 years, after 2 years 6 months of Tamoxifen therapy. Endometrial thickness = 12 mm. Endometrial tissue has a “honeycomb” appearance. A single vessel is visualized (color Doppler mapping) (a). A broad-based endometrial polyp with inclusion cysts, measuring 15 × 12 mm, is visualized along the posterior wall of the uterus (sonohysteroscopy) (b)

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Copyright (c) 2018 Protasova A.E., Solntseva I.A., Tsypurdeyeva A.A., Semiglazova T.Y., Stenina M.B., Yureneva S.V., Yakushevskaya O.V.

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This work is licensed under a Creative Commons Attribution 4.0 International License.

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