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The data on the adjuvant therapy of endometrial cancer (EC) are inconsistent. Recent studies of this topic such as PORTEC-3, GOG-258 and GOG-249 investigated the value of adjuvant radiotherapy, adjuvant chemotherapy and combined adjuvant chemoradiotherapy followed by chemotherapy in patients with endometrial cancer and an increased risk of recurrence. With this statement, the Uterus Committee of the Gynaecological Oncology Working Group (AGO) wishes therefore to interpret the new data and discuss them against the background of the new S3 guideline "Diagnosis, treatment and follow-up of patients with endometrial cancer".Die Datenlage zur adjuvanten Therapie des Endometriumkarzinoms (EC) ist widersprüchlich. Neue Studien zu diesem Thema wie PORTEC-3, GOG-258 und GOG-249 untersuchten die Wertigkeit der adjuvanten Strahlentherapie, der adjuvanten Chemotherapie und der kombinierten adjuvanten Strahlenchemotherapie gefolgt von einer Chemotherapie bei Patientinnen mit Endometriumkarzinom und einem erhöhten Rezidivrisiko. Die Kommission Uterus der Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) möchte daher mit dieser Stellungnahme die neuen Daten interpretieren und vor dem Hintergrund der neuen S3-Leitlinie „Diagnostik, Therapie und Nachsorge der Patientinnen mit Endometriumkarzinom“ diskutieren.

2.1 Target audience The guideline was compiled with the aim of providing high-risk groups with advice on diagnostics, surgical and systemic therapy in early and advanced stages of disease together with the treatment of rare histological subtypes. A lot of emphasis has been placed on follow-up care, rehabilitation, palliative therapy and psycho-oncological counselling. The recommendations are for physicians working both in hospitals and outpatient clinics, nursing staff and other medical partners involved in treating patients with malignant ovarian tumours. As it also covers the topics ‘Screening’ and ‘Follow-up’, registered physicians working in their own practice are also an important target audience of this guideline. It is additionally intended to offer guidance to affected patients and persons seeking more information as well as providing a basis for the gynaecological cancer centres currently being set up in Germany. For the first time, scientific medical societies in Switzerland and Austria were also consulted, expanding the scope of this guideline.

Zielsetzung: Eine Besonderheit maligner Zellen ist die erhohte Glukoseaufnahme und die Steigerung der anaeroben Glykolyse. Durch gezielte Hemmung der Glykolyse kommt es zum Zelltod entarteter Zellen. Ein wirksamer Glykolyseinhibitor ist 2-Deoxy-D-Glukose (2DG), das statt Glukose in die Zellen aufgenommen wird, dort nicht weiter verstoffwechselt werden kann und so Apoptose induziert. Fur das Antidiabetikum Metformin wurde bereits eine antitumorale Wirkung gezeigt. In dieser Studie wurde untersucht, ob durch Kombination von 2DG mit Metformin die Antitumorwirkung gesteigert werden kann. Material und Methoden: Die Viabilitat der Mammakarzinomzelllinien MCF-7 und MDA-MB-231 wurde mittels Alamar-Blue Assay quantifiziert. Die Beurteilung der Apoptoserate erfolgte durch Messung des mitochondrialen Membranpotentials (JC-1). Ergebnisse: Die Behandlung der Mammakarzinomzellen mit 10 mM 2DG fuhrte zu einer signifikanten Reduktion der Viabilitat [MCF-7: 55,5 ± 7,9% SEM; p < 0,001 vs. Kontrolle; MDA-MB-231: 42,5 ± 6,1% SEM; p < 0,001 vs. Kontrolle]. Metformin (2,5 mM) reduzierte die Viabilitat auf 64,8 ± 4,5% SEM [MCF-7; p < 0,001 vs. Kontrolle] bzw. 64,5 ± 8,3% SEM [MDA-MB-231; p < 0,001 vs. Kontrolle]. Durch Kombinationsbehandlung mit 10 mM 2DG und 2,5 mM Metformin konnte die Viabilitat signifikant starker reduziert werden, als durch die jeweiligen Einzelbehandlungen [MCF-7: 21,7 ± 3,7% SEM; p < 0,001 vs. Kontrolle; p < 0,001 vs. 2,5 mM Metformin; p < 0,001 vs. 5mM 2DG//MDA-MB-231: 25,1 ± 1,2% SEM; p < 0,001 vs. Kontrolle; p < 0,001 vs. 2,5 mM Metformin; p < 0,05 vs. 5mM 2DG)]. Zusammenfassung: Die Behandlung der verschiedenen Mammakarzinomzellen mit 2DG in Kombination mit Metformin zeigt eine signifikant bessere antitumorale Wirkung im Vergleich zur Einzelbehandlung.

Patientinnen mit primarem Mammakarzinom leiden nicht selten unter den Folgen der Therapie. Gerade Langzeit-Nebenwirkungen sind bei der relativ guten Prognose der Erkrankung von Bedeutung. Solche Nebenwirkungen konnen durch Operation, Strahlentherapie, Chemotherapie oder endokrine Therapie hervorgerufen werden. Viele Patientinnen leiden an Symptomen des Ostrogenmangels. Zu deren Behandlung kommt eine Reihe von verschiedenen Methoden in Betracht. Gesunde Frauen erhalten zur Therapie von Ostrogenmangelerscheinungen haufig Ostrogene ggf. in Kombination mit Gestagenen. Ostrogene haben unter allen heute verfugbaren Methoden die beste Wirkung auf klimakterische Beschwerden, insbesondere Hitzewallungen und Schweisausbruche. In den letzten Jahren wurde eine Reihe von vermuteten Nebenwirkungen u.a. auch aus randomisiert-kontrollierten Studien bestatigt (Thromboembolien, Schlaganfall, Brustkrebs, u. a.). Zusatzlich bewahrheiteten sich zwar positive Effekte auf Osteoporose und osteoporotische Frakturen. Die uber viele Jahre vermutete Pravention von kardiovaskularen Erkrankungen ist aber aufgrund jungerer Untersuchungen nicht vorhanden oder zumindest zweifelhaft. Gesunde Frauen sollten derzeit nur bei bestehender Indikation, d. h. in der Regel zur Behandlung von klimakterischen Beschwerden und/oder Urogenitalatrophie eine Hormontherapie erhalten. Bei Frauen mit behandeltem Brustkrebs ist eine Hormontherapie kontraindiziert. Diese Patientinnen konnen allerdings aufgrund einer naturlichen postmenopausalen Situation oder therapiebedingt viele Jahre unter klimakterischen Beschwerden leiden. Es ist daher wichtig, nach Alternativen der Behandlung dieser relevanten Probleme zu suchen. In diesem Heft werden die verschiedenen Optionen sowie deren Nutzen und Risiken dargestellt.

The S2k guideline "Diagnostics and Therapy for Cervical Cancer" published in 2008 is currently being revised to the S3 level. Current developments in epidemiology, surgical therapy, radiochemotherapy and drug therapy will be presented. The S2k guideline "Diagnostics and Therapy for Endometrial Cancer" will also be up-dated this year. The revised recommendations on early diagnosis and diagnostics, therapy for precursors, surgical therapy, adjuvant therapy and therapy for recurrences and metastases will be presented.Die S2k-Leitline „Diagnostik und Therapie des Zervixkarzinoms“ aus dem Jahr 2008 wird derzeit auf S3-Niveau angehoben. Die aktuellen Entwicklungen der Epidemiologie, operativen Therapie, Radiochemotherapie und medikamentösen Therapie werden dargestellt. Die S2k-Leitlinien „Diagnostik und Therapie des Endometriumkarzinoms“ wurden in diesem Jahr ebenfalls aktualisiert. Die aktualisierten Empfehlungen zur Früherkennung und Diagnostik, Therapie der Vorstufen, operativen Therapie, adjuvanten Therapie und Therapie bei Rezidiven und Metastasen werden dargestellt.

Female urinary incontinence is a frequent disease. Diagnostic work-up and treatment depend on the subjectively perceived suffering. The diagnostic tools available comprise a specific history and gynecologic examination including the cough test/pad test, analysis of a micturition protocol, and urogynecologic ultrasonography. In addition, urodynamic measurements contribute useful information for determining the type of urinary incontinence. Cystometry provides data on the motor and sensory function of the bladder in the differential diagnosis of urge incontinence (detrusor overactivity). A urethral pressure profile can yield information on stress urinary incontinence (disturbed urethral closure). Urodynamic testing is indicated in patients in whom primary (conservative or surgical) therapy failed, prior to any form of incontinence surgery, and to identify the type of incontinence in inconclusive cases. Urodynamic measurements alone do not yield a diagnosis but provide objective data on bladder and urethral function. This review presents a short outline of the pathophysiology of female urinary incontinence and discusses the range of urodynamic diagnostic tests currently available to the attending physician in planning therapy.

The multifactorial disease of osteoporosis is one of the most frequent diseases, affecting about 5 - 6 Mio. postmenopausal women in Germany, today. In spite of the introduction of new technologies of fracture risk assessment and new pharmacological opportunities the incidence of fracture is still increasing. Therefore, early identification of women at high risk as well as early and individualised preventive measures are essential in the prevention of osteoporosis. Changes of dietary habits as well as lifestyle including an increase in physical activity are of up most importance. In addition to Calcium and Vitamin D supplementation, hormone replacement therapy (HRT) is accepted as the first line and cost effective pharmacological treatment for the prevention of osteoporosis. Numerous cross sectional, case-control and prospective studies showing the effect of HRT on bone reabsorption and bone mineral density (BMD) have been published. HRT reduces bone turnover which is followed by an increase of BMD. A number of case-control and cohort studies as well as a few recent prospective studies have been investigating the effect of HRT on osteoporosis related fracture. These studies confirm that HRT leads to a significant decrease of osteoporosis related fracture (Hip fracture by > 25%). However, randomised, prospective studies are needed to underline the effect on osteoporosis related fracture. Although the effect of HRT on BMD is independent of both, the age at which treatment is started and the route of administration, a dose-response relation as well as a greater response in patients with a lower initial BMD has been reported. Since bone is lost rapidly when treatment is stopped, the duration of treatment is clinically important in evaluating the effect of HRT on BMD. Hereby, a duration of 10 years and more seems desirable. Since the ongoing controversial discussion on the duration dependent increase of the incidence of breast cancer and the discussion on secondary prevention of cardiovascular disease, any therapy decision must be individually evaluated. The following article gives a systematical review on the recent literature regarding the influence of HRT on BMD and osteoporosis related fracture.

Puerperal sepsis is a rare but serious and potentially lethal syndrome. It is imperative that severe postpartum malaise is taken seriously; early initiation of antibiotic therapy before sepsis becomes manifest can save lives.

The use of hormone replacement therapy in breast cancer patients with climacteric symptoms has been discussed controversially. In 2003, the HABITS study was stopped after accrual of 434 patients, who had received HRT, due to an increased risk of metastases and recurrence. The LIBERATE study included 3148 women with vasomotor symptoms during the adjuvant phase after surgically treated breast cancer. Patients were randomly assigned to treatment with either 2.5 mg tibolone daily or placebo. Most of the patients were ER positive, the mean duration of therapy was 2.1 years. Tibolone-treated patients had significantly less osteoporosis and bone fractures. Especially patients with osteoporosis at start of therapy benefited from tibolone. The relative risk of breast cancer recurrence and metastasis, however, increased by 40 %. In hormone receptor positive patients the relative risk increase was 56 %. The increase in relative risk in ER negative patients was 15 %. In 202 patients who were treated with tibolone and aromatase inhibitors, the hazard ratio was 2.42 compared to placebo. These data demonstrate that tibolone increases the risk of recurrence in breast cancer patients and is therefore contraindicated in this setting.

A 37-year-old G7P4 in the 16th gestational week presented with a 1.5 cm breast mass. Biopsy showed grade 3 invasive carcinoma. The patient underwent mastectomy and axillary dissection. Histology showed a pT1c pN0 tumor that stained negative for estrogen and progesterone receptors. Adjuvantly the patient received four cycles of Adriamcyin (50 mg/m 2 ) and cyclophosphamide (600 mg/m 2 ). Elective caesarean delivery was performed at 35 weeks' gestation because of intrauterine growth retardation, oligohydramnios, and breech presentation. Postnatal development was normal.

Objective: Because estrogens are important in the pathogenesis of both breast cancer and osteoporosis, it has been suggested that the risk of osteoporosis and breast cancer are inversely related. The aim of our study was to evaluate bone mineral density in patients with breast cancer. Methods: Speed of sound, broadband ultrasound attenuation, and the stiffness index of the calcaneus were measured in 1004 subjects (mean age 53.9 years) with an Achilles ultrasound bone densitometer. 148 patients had a history of breast cancer and 856 did not. Breast cancer patients were compared with healthy subjects matched for age, weight, body mass index (BMI), parity, and duration of breast feeding and estrogen exposure. Results: Overall, the patients with breast cancer were 4.4 years older and had higher body weight, BMI and parity, longer duration of breast feeding and estrogen exposure, and a significantly higher speed of sound and stiffness index than healthy controls. In the matched-pairs analysis, women with breast cancer had a higher speed of sound and stiffness index than the controls. Conclusion: Women with breast cancer have a lower risk of osteoporosis than controls. Although the biologic mechanisms linking bone mass and the risk of breast cancer are not fully understood, factors other than cumulative estrogen exposure may play a role. Studies on larger populations are needed to evaluate this relationship.

Purpose: This cross-sectional study collected data on the effectiveness, validity and reliability of QUS. Method and Material: Speed of sound (SOS), broadband ultrasound attenuation (BUA) and stiffness index (SI) of the calcaneus were measured in n = 764 postmenopausal patients, mean age 61 years, using the Achilles ultrasound bone densitometer (Lunar Corp., Madison, WI). In addition we measured blood levels of E2 and FSH in 157 patients and correlated these variables with data gathered by a detailed questionnaire. Women using any medication known to effect bone metabolism were excluded from the study. Results: The Achilles shortterm precision in vivo expressed as coefficient of variance was 1.2 % for BUA and 0.17% for SOS and 1.3% for stiffness respectively. A total of 102 women were measured at the right and left calcaneus with a coefficient of correlation of r= 0.92 for SOS, r = 0.84 for BUA and r = 0.93 for SI. Cross-sectional analysis showed a significant yearly postmenopausal decrease of 0.06% for SOS, 0.44% for BUA and 0.74% for SI. Women with a history of osteoporosis (165 patients) as well as 141 women with an osteoporosis-related fracture showed significantly lower results in all ultrasound parameters (SOS, BUA, SI). In conclusion, quantitative ultrasound osteodensitometry of the calcaneus measures properties of bone which continue to decline with age. The low precision error and the high correlation of right vs. left underlines the high technical standard. Conclusion: Our results indicate that QUS is capable of identifying in a precise manner women with previous osteoporotic fractures as well as women with a history of osteoporosis. Hence, QUS may provide a radiation-free, low-cost, easy to handle, fast and mobile method which for the first time could make a screening programme a feasible proposition.

A 65-year old patient, suspected to be suffering from an androgen producing ovarian tumour, was treated preoperatively with the GnRH agonist triptorelin (500 micrograms/day s.c.) for 7 days. After an initial rise, gonadotrophin levels were suppressed under this treatment. The elevated serum testosterone concentrations were reduced by approx. 50% by the triptorelin injections. After the extirpation of the tumour (histologically a Leydig cell tumour of the ovary without signs of malignancy), primary cell cultures which secreted testosterone and androstenedione were prepared. Coincubation of the tumour cells with the GnRH agonist triptorelin had no effect on their androgen secretion. Treatment of the tumour cells with high concentrations (10(-5) M) of a GnRH antagonist, however, resulted in a 100% increase of their testosterone and androstenedione secretion. GnRH-binding sites of low affinity (Ka = 0.54 x 10(5) M-1) and high capacity (B max = 1364 x 10(-12) M/mg membrane protein) were identified in the tumour. These findings suggest that GnRH analogues might modify androgen secretion of sex-cord stromal tumours of the ovary via the suppression of endogenous gonadotrophin secretion and possibly also via direct effects on the tumour cells.