
We recommend that all female LMS owners have their tumor tested for estrogen and progestogen receptors. While many of the uterine LMS cells are positive for either estrogen receptors or progestogen receptors or both, sometimes LMS tumors of other sites also have hormone receptors. So maybe ALL LMS owners should have estrogen and progestogen receptor tests done on their tumors? If the tumor is positive for estrogen receptors, or for progestogen receptors, these hormones will stimulate those tumor cells to grow. Even after a hysterectomy, your body produces some estrogen and progestogen in other tissues. If your tumor is estrogen or progestogen receptor positive, or both, you might want to consider hormonal management. The agents for these interventions are MUCH kinder than chemotherapy agents.

[Do NOT use Raloxifene. Do NOT use Tamoxifen. There is a suggestion now that perhaps Raloxifene (Evista) has increased growth of an ovarian cancer. Tamoxifen has been implicated in possibly causing LMS, where it has been used for preventing breast cancer progression.] 

Progestogen and estrogen receptor tests are also tests done with 'stains'; they are 'dye' tests. Often tests done on tumors have a 20% cut-off point, so they are read as negative, even if 19% of the cells respond positively. So sometimes even if the test is read as negative you might have benefit from hormone directed therapy. You might ask your friendly pathologist to review the original test slides and see if there is ANY staining? Or if it is possible, have a PCR or probe type test done on the tumor for estrogen and progestogen receptors.

Jim wrote:
"As others have noted, estrogen/progesterone receptor testing is important for uterine LMS, and it can be done on wax embedded tissue sections which will have been saved from the op. If these are positive, then consider anti-oestrogen therapy. Even if negative, stay away from HRT - frankly it is not worth the risk that it may stimulate any remaining cells and make them grow quicker." "If the lady is unlucky and has symptoms (hot flushes etc) then look at other forms of post menopausal relief. The best advice given here is always to make sure that you have a sarcoma specialist on your team even if you only travel for the advice and then have all your treatment done locally. Other than that, make sure of getting scans every 3 months for a couple of years and then drop to 6 months, and let's hope they are always clear." 

Environ Health Perspect 2000 Oct;108 Suppl 5:785-90 
<b>Regulation of vascular endothelial growth factor expression by estrogens and progestins.</b> 
Hyder SM, Huang JC, Nawaz Z, Boettger-Tong H, Makela S, Chiappetta C, Stancel GM. 
Department of Integrative Biology and Pharmacology, University of Texas-Houston Medical School, Houston, Texas 77225, USA. 

"<b>Estrogens increase the expression of vascular endothelial growth factor (VEGF) mRNA in the rodent uterus. This regulatory effect is rapid, beginning within 1 hr after hormone treatment, dose dependent, and blocked by the pure antiestrogen ICI 182,780. </b>
The induction of the transcript is blocked by inhibitors of RNA but not of protein synthesis, and we have recently identified estrogen response elements in the VEGF gene. Collectively, these findings indicate that estrogens regulate uterine VEGF expression at the transcriptional level via the classical nuclear estrogen receptor pathway. Estrogen induction of VEGF occurs in the stromal layer of the rodent uterus, and estradiol induces expression of VEGF transcript levels in cultured human uterine stromal cells. Progestins also induce VEGF expression in the rodent uterus, although the effect is less marked and slower in onset than estrogenic effects. The effect of progestins is blocked by the antiprogestin mifepristone (RU-486), suggesting that it is also mediated by a classical nuclear receptor pathway. In addition, progestins regulate expression of VEGF mRNA and protein in cultured human T47-D breast cancer cells. The development of uterine leiomyomas is associated with exposure to ovarian sex steroids, abnormal uterine bleeding is commonly seen in patients with leiomyomas, and fibroids require an increased vascular supply for their growth. These observations suggest that VEGF and other angiogenic factors may represent potential targets for the treatment and prevention of uterine fibroids. "
&&url PMID: 11035983

For More Information on &&url 
For More Information on &&url
