Abnormalities of the genital tract following stilbestrol exposure in utero

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Abstract

A large number of children and young women have been exposed to DES in utero and 15% of the patients in the Registry files were asymptomatic when their tumors were discovered. Moreover, in contrast to the survival of 75% for the entire group of patients, none of those that were asymptomatic at the time of diagnosis have died although the tumors recurred. The obvious question is whether or not all children and women with a history of exposure should undergo screening examinations. Since less than 10% of the patients with carcinoma have been under 12 years of age, it does not seem reasonable to subject exposed pubertal children to multiple examinations, which require general anesthesia. Furthermore, only one-half of the patients in this age group in the Registry files had a history of DES exposure, so the others would not have been identified by screening examinations. Consequently it has been suggested that unless a prepubertal child has vaginal bleeding or discharge, pelvic examination can be deferred to the time of menarche or by the age of 14 years if the menarche has not occurred. At this time all females with a history of DES exposure should be examined. The examination should include careful palpation and direct visualization supplemented with iodine staining. Colposcopy is a valuable adjunct for investigative purposes, but is not necessary for the detection of clear-cell carcinoma. Biopsy of all suspicious areas is mandatory as these tumors may be quite small and difficult to detect even with careful colposcopic examination. Cytology is a useful screening examination if the anterior, posterior, and lateral walls of the vagina are scraped but cannot be considered entirely reliable because of the relative frequency of false negative findings. At the present time it does not appear necessary for male offspring of DES-treated mothers to be screened for malignant tumors as no increased incidence of neoplasms has been reported. The only alterations detected so far have been abnormalities of sperm including decreased counts, abnormal forms, and decreased mobility and small epididymal cysts.

Original languageEnglish (US)
Pages (from-to)161-174
Number of pages14
JournalRecent Results in Cancer Research
VolumeVol. 66
StatePublished - Dec 1 1979
Externally publishedYes

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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