, Risicofactoren:
Endometrioide endometriumcarcinoom door onevenwicht in oestrogeen/progestageen balans
• vaker bij nulliparen: vaker anovulatoire cycli met luteale insuffici ntie ! oestrogeenoverwicht
• zeer jonge pati nten (<40 jaar): geassocieerd met infertiliteit, vnl. pati nten met polycystische ovaria
Risicofactoren • Triade obesitas, hypertensie en diabetes
vnl. obesitas belangrijkste geassocieerde factor: androstenedion geproduceerd in bijnier ! t.h.v. vet omgezet tot oestron !
Dé risicofactor = oestrogenen meer actieve oestradiol
• Nullipare patiënten of infertiliteit/PCOS 25 kg overgewicht = 10 x hoger risico
• Obesitas (E1 omzetting vet) ! hypertensie, diabetes tijdens postmenopauze oestrogeenproductie t.h.v. vet niet tegengewerkt door progestagenenproductie = verhoogd risico
• Oestrogeen therapie zonder progesterone (menopauze)
• Leverinsuffici ntie: verlaagde afbraak E
• Tamoxifen = “antioestrogeen” “SERM”.
• gebruik E voor menopauzale klachten (zonder progestagenen)
• Leverinsufficiëntie (tragere afbraak E)
• Oestrogeen producerende tumoren
(vnl. ovarieel, granulosceltumor (8% - End.ca.)
Tamoxifen
= antioestrogeen
vaak gebruikt bij behandeling borstcarcinoom
zwak oestrogene werking op endometrium: bij langdurig (> 2 jaar) gebruik ook gepaard met verhoging aantal endometriumcarcinomen
Selective Estrogen Receptor Modulator (SERM)
E Tamoxifen Raloxifen
(Nolvadex) (Evista)
Risicofactoren
• Hereditary Non Poliposis Colorectal Cancer (HNPCC)
= Lynch Syndroom
• Defect in mismatch repair genen (MLH1, MSH2, MSH6, PMS2)
• Risico’s:
• 25-70%: Colorectaal ca.
• 25-70%: Endometriumca.
• 10-20%: Maagca.
• 5-10%: Ovariumca.
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