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The following is an archived discussion of a featured article nomination. Please do not modify it. Subsequent comments should be made on the article's talk page or in Wikipedia talk:Featured article candidates. No further edits should be made to this page.

The article was promoted by Ian Rose via FACBot (talk) 08:10, 26 October 2014 (UTC) [1].[reply]

Endometrial cancer

[edit]
Nominator(s): Keilana|Parlez ici 23:40, 31 August 2014 (UTC)[reply]

This article is about the fourth most prevalent cancer in women, very highly viewed and quite important. The article has been improved substantially in the past weeks by a peer review, GA review, and an expert review from Cancer Research UK. Keilana|Parlez ici 23:40, 31 August 2014 (UTC)[reply]

  • Well, Kei, I guess I'll review this... but we all know I don't know anything about medicine (the ear bone's connected to the ... what now?)
  • Globally, as of 2012, endometrial cancers occurred in 320,000 women and caused 76,000 deaths. - "As of" would be present tense, as it is something that holds true or we expect to hold true. I'd use "in 2012" as the numbers can change dramatically from year to year.
Done
  • What's with all the hidden refs? When at the end of a paragraph, one would expect a footnote (i.e. Abnormal menstrual periods or extremely long, heavy, or frequent episodes of bleeding in women before menopause may also be a sign of endometrial cancer.)
  • For those at the end of a paragraph (such as the one I quoted) I'd make the ref apparent. People generally assume that a ref doesn't cover paragraphs before the paragraph in which the ref is located. — Crisco 1492 (talk) 01:05, 4 September 2014 (UTC)[reply]
Done
  • Symptoms, other than bleeding, do not occur commonly. - "Commonly do not occur" or "there are few in common" or... I feel this could probably be reworked
Done
  • You really need to check for duplicate links. I've gotten two or three in the same paragraph. I'm not removing any more as there are too many.
Done
  • by 3-4 times - by 300 to 400%, or another reworking. "By 3 to 4 times" just feels off
Done
  • Ovarian cancer and endometrial cancer - why the extra "cancers"? Couple instances of this
Done
  • There is a loose association because breast and ovarian cancers are often treated with tamoxifen. - the treatment causes the illness? That's what it reads like to me. What you intend (I think) is that the treatment of another kind of cancer (tamoxifen) can cause endometrial cancer, but that's not what the wording conveys to me. The connection only becomes clear in the following paragraph
Done
  • Women with this disorder have a 5-10% lifetime risk of developing endometrial cancer. - as opposed to ...?
Done As opposed to a normal 2-3% risk, clarified.
Done
  • is not currently significant - when, exactly, is "currently"?
Done
  • CDKN2A are both dablinks
Done
  • 10-20% of endometrial cancers, - I'd refactor to avoid starting sentences with numerals
Done
  • 20% of endometrioid - again
Done
  • 8-30% of atypical - again
Done
  • Why does the Mani source not have vol, issue, and page numbers?
It was an e-publication ahead of print - I don't think it's been printed yet.
@Crisco 1492: For some reason it doesn't. I'm confused too... Keilana|Parlez ici 17:55, 6 September 2014 (UTC)[reply]
  • "Article in press"... if it weren't for the publication saying it's alright to cite, I'd be wary... who's to say that there will be no major changes in the process? Anywho, it looks fine to me in this case. — Crisco 1492 (talk) 23:58, 6 September 2014 (UTC)[reply]
Generally article in press means all changes have already been made and the only further changes will be to page numbers etc as it hasn't been published in the print edition yet and assigned those minor details. Since that comment, it has now been assigned those details, Second Quantization (talk) 13:11, 26 September 2014 (UTC)[reply]
  • The single-sentence or single paragraphs sections a bit further south look really rough. Any way to either expand and/or merge?
If you're referring to the section on other carcinomas, I've looked for information and since there are only about 100 known cases each of both squamous cell carcinoma of the endometrium and transitional cell carcinoma, it's hard to find anything meeting MEDRS. I've found a couple promising papers but they're quite dense. More to come on this later - I've been overloaded with molecular path and evo/devo papers this week and need a day to unscramble my poor brain.
Okay. I went diving in PubMed and mined the only two relevant MEDRS-ish sources for PSCCE. I did use an article that had both case reports and a review of the literature because my options were very limited. There aren't any reviews of the past 5 years covering transitional cell carcinoma of the endometrium (it's that rare) so I'm going to go slightly outside of that in order to get something on TCCE. Keilana|Parlez ici 17:51, 6 September 2014 (UTC)[reply]
Done
@Crisco 1492: Thank you so much for all your comments! I think I've satisfied most of your concerns from this section. I'll keep plugging away this weekend. Keilana|Parlez ici 15:55, 5 September 2014 (UTC)[reply]
  • being highly suspicious for endometrial cancer. - Was the patient suspicious, or... what's meant here?
Done - Clarified that the finding is what's suspicious.
  • both an endometrial biopsy and a transvaginal ultrasound - so used in conjunction?
Yup. Not sure how to make this clearer beyond saying "used in conjunction".
I mean, they evolve from hyperplasia... ;) Done
  • have a good outcome - prognosis? I can't imagine a cancer left unchecked having a "good" outcome. Prognosis, at least, implies treatment.
Done
  • The CTNNB1 (beta-catenin) mutation is most commonly mutated in the squamous subtype of endometrioid adenocarcinoma. - mutation - mutated; can we avoid the repetition
Yeah, we can. Done
  • 30% of endometrial serous carcinomas - more numerals
Not sure what the issue is here?
  • Sentences starting with numerals (or, at least, were when I reviewed)
Ah. Done.
  • pelvic and para-aortal nodes - I don't think these are linked yet
Done
Done
  • is performed for tumors of histologic grade II or above. Lymphadenectomy is routinely performed for all stages of endometrial cancer in the United States, but in the United Kingdom, the lymph nodes are typically only removed with disease of stage II or greater. - redundant
I'm not sure how this is redundant, since histologic grade and disease stage are different. Am I missing something?
  • 90% of women are treated with some form of surgery - another sentence beginning with numerals. Also, this would work much better closing the paragraph
Done
  • In stage IV disease, where there are distant metastases, surgery can be used as part of palliative therapy. - could this be merged somewhere?
Done
  • happen about 5-10% of the time - "happen in about 5-10% of cases" might be more professional.
Done
  • dilation and curettage (D&C) - you've already linked this and given the abbreviation. You should just use D&C, or get rid of the abbreviation altogether and use the full name
Done
Done
  • Mutations in mismatch repair genes can lead to resistance against platins, meaning that chemotherapy with platins is ineffective in people with these mutations. - if this is related to Lymph disease or another condition which exacerbates the disease, we might want to be more explicit
Done
  • shows tumor invading the cervix, - This feels rough to me, though if it's the proper terminology I'll push that concern aside
Invasion is the technical term, yeah. Not sure how to write that without compromising the scientific meaning.
  • 25% of metastatic endometrioid - again
Done
  • Also, endometrial stromal sarcomas can be treated with hormonal agents, including tamoxifen, 17-hydroxyprogesterone caproate, letrozole, megestrol acetate, and medroxyprogesterone - and how well do these work?
Jury's out. I could go into more extensive detail about various studies and such if you think that wouldn't be overkill.
K, I've expanded the bits on hormonal treatment of ESS, added some to Research about hormonal agents, and expanded the ESS section itself. Better? (It's super rare so hard to find MEDRS on it.) Keilana|Parlez ici 00:04, 12 September 2014 (UTC)[reply]
  • Research is ongoing in this area. - as of?
Same as the other ones, mid-2010s. Done
  • You have a hidden note about the table being US figures... why isn't this noted in the article?
It should be. Done
  • Older age indicates a worse prognosis. - "older age" is a bit rough, I think. "There is a negative relationship between patients' ages and survival rates." would be more professional, or something similar.
@Crisco 1492: I'm not sure if that's clear enough for the lay reader, perhaps something like "Survival rates are lower for older women"? Keilana|Parlez ici 01:58, 12 September 2014 (UTC)[reply]
  • Higher-staged cancers are more likely to recur — those that have invaded the myometrium or cervix, or that have metastasized into the lymphatic system, are particularly likely to recur. - Could we avoid "likely to recur" being in the article twice? Perhaps " Higher-staged cancers are more likely to recur, as are those that have invaded the myometrium or cervix, or that have metastasized into the lymphatic system."
Done
  • If a cancer treated with radiation occurs, - occurs -> recurs?
Uh, yeah. Done.
  • Worldwide, approximately 320,000 women are diagnosed with endometrial cancer each year and 76,000 die, making it the sixth most common cancer in women. - date of statistics?
2014. Done
  • Too much repetition of "developed countries" in #Epidemiology
Not sure how to reduce that without making stats unclear. Any ideas?
I personally prefer to avoid it. Keilana|Parlez ici 04:05, 12 September 2014 (UTC)[reply]
  • Northern Europe, Eastern Europe, and North America have the highest rates of endometrial cancer, comprising 48% of diagnoses in 2012, whereas Africa and West Asia have the lowest rates. Asia saw 41% of the world's endometrial cancer diagnoses in 2012. - That's three continents making up 48%, compared to one continent making up 41%. How do three individually have higher rates than Asia alone? Concerning...
Not quite sure what the worry is here, but it might be helped by "together comprising 48% of diagnoses ....". Obviously Asia has by far the largest pop. Wiki CRUK John (talk) 12:19, 4 September 2014 (UTC)[reply]
  • most frequently during perimenopause and menopause, between the ages of 50 and 65; overall, 75% of endometrial cancer occurs after menopause. - Feels contradictory: if 75% of cancer cases occur after menopause, then during menopause it wouldn't be "most frequent"
Perimenopause and menopause together are most frequent - perimenopause includes after menopause. Keilana|Parlez ici 01:58, 12 September 2014 (UTC)[reply]
  • Indeed, but perimenopause (according to the menopause article) also includes "before menopause"... which, to me, at least, means pretty much any woman from age 35 to 65 (or however menopausal age is defined) is most frequently affected. — Crisco 1492 (talk) 02:28, 12 September 2014 (UTC)[reply]
Yeah, unfortunately the source isn't more specific. Should I just remove the bit about perimenopause/menopause? Keilana|Parlez ici 04:05, 12 September 2014 (UTC)[reply]
  • 5% of cases occur in women younger than 40 and 10-15% occur in women under 50 years of age. - another numeral
Done
  • is still underway. - as of?
Probably, for most/all of these: "now, 5 years ago and in 10 years time". It's a very slow process, with research before and after anything affects clinical practice. It's probably best to start the section with some blanket statement including a vague date "in the middle 2010s" maybe. Wiki CRUK John (talk) 12:19, 4 September 2014 (UTC)[reply]
Done
  • Research is ongoing on the use of metformin, a diabetes medication, - again, as of?
Done
  • in the first place, - feels non-formal. Perhaps "Long-term use of metformin has not been shown to have a preventative effect against developing cancer (?or, "the development of cancer"?), but may improve overall survival."
Done
  • Temsirolimus, an mTOR inhibitor, is under investigation as a potential treatment. - again
per above, included in the "mid-2010s" umbrella. Done
  • <-- hormonal stuff --> - I know this is hidden text, but... "stuff"?
uh. "hormonal research". Done.
  • Hormone therapy that is effective in breast cancer - in treating, perhaps?
Yeah, done
  • The last three paragraphs are much too short
Merged.
As above.
  • I'm getting error messages from some of your cites: "Endometrial Cancer Treatment (PDQ®)" and "General Information About Endometrial Cancer"" have date errors, and Lee JM and Banerjee S, use deprecated parameters. — Crisco 1492 (talk) 09:40, 3 September 2014 (UTC)[reply]
I'm not getting error messages from either of those sources. Maybe someone came by and fixed it? Keilana|Parlez ici 01:58, 12 September 2014 (UTC)[reply]
Ooooh, I see what you mean. Fixed now. :) Keilana|Parlez ici 04:05, 12 September 2014 (UTC)[reply]
Done.


Can't find either of them but the website is really difficult to navigate. I've removed them for now, until I can dig up the originals.Keilana|Parlez ici 02:50, 12 September 2014 (UTC)[reply]
    • File:Endometrial adenocarcinoma (1).jpg - Fine
    • File:EndometrialStromalSarcoma.JPG - I'm not seeing evidence that the uploader is the copyright holder. Web resolution and quality / type of other nominations suggest (to me) that s/he may not be. Since the side-by-side presentation looks a little rough (and the image sizes are uneven) losing it is not too much of a blow.
K, removed. Keilana|Parlez ici 02:50, 12 September 2014 (UTC)[reply]
Found it. Keilana|Parlez ici 02:50, 12 September 2014 (UTC)[reply]
See Wikipedia:WikiProject_CRUK. There is an OTRS ticket wending its way here, which will be added to all these via the template, I hope in a few days. As WiR, I can confirm the release has been approved by CRUK, who supplied Fae with the svg files. Wiki CRUK John (talk) 12:12, 3 September 2014 (UTC)[reply]
Isn't that what MediaViewer is for? ;) In all seriousness, I'm not sure there's a better option. Keilana|Parlez ici 02:50, 12 September 2014 (UTC)[reply]
I'm gonna steal your fancy gallery thingy and stick the gross path somewhere else. Keilana|Parlez ici 04:05, 12 September 2014 (UTC)[reply]
Thank you very much for the review and your support! The article is much better for it. :) Keilana|Parlez ici 14:21, 16 September 2014 (UTC)[reply]

Source review - spotchecks not done, building on what Crisco's already said

Done
  • Where you have page ranges for chapters, it would be helpful to include them
A lot of these are e-books and don't have page ranges. Is that okay?
Yes, just good to have when you have them. Nikkimaria (talk) 03:01, 12 September 2014 (UTC)[reply]
  • Sometimes you're abbreviating journal titles, other times not - be consistent
Done
  • FN19 has doubled quote marks
Seppi got this one too.
I think the citation number has changed, could you point me to this again?
I appear to have fixed the MM/DD/YYYY and FN19 issues you noted while performing the MOS-related edits in my review. Seppi333 (Insert 2¢ | Maintained) 21:14, 9 September 2014 (UTC)[reply]
@Nikkimaria: Thanks much for the review! I think I've taken care of or responded to everything. Thanks also Seppi for your fixes. :) Keilana|Parlez ici 02:50, 12 September 2014 (UTC)[reply]
43 is now 47; a couple of other replies above. Nikkimaria (talk) 03:01, 12 September 2014 (UTC)[reply]
Thanks, took care of 47. Keilana|Parlez ici 04:05, 12 September 2014 (UTC)[reply]

Review by Seppi333

[edit]

I went ahead and fixed all the issues with MOS:CAPTION, MOS:IMAGELOCATION, MOS:NDASH, MOS:MDASH, MOS:DATEFORMAT, MOS:NBSP, MOS:NUMERAL, MOS:%, and MOS:FRAC that I could find - diff of those changes.

Thank you!! :) Keilana|Parlez ici 03:35, 12 September 2014 (UTC)[reply]
  • I'll review the prose later this week, though I did notice that the capitalization of the word "type" isn't consistent in the article. In some cases, "Type I" and "Type II" is used and elsewhere it's written as "type I" and "type II".
Done
Done

History and culture

[edit]

Currently this article lacks any section about the cultural impact of this condition. For such a common disease it seems that it hardly exists in popular discussion. I do not expect much, but I would like either a history or society and culture section here, even if that is just a single sentence where someone says "No sources discuss the history of recognizing this condition.(citation needed)"

Here are the oldest sources I could find on PubMed. I cannot read them. Maybe one of them says something about the early history of treatment or recognition of the disease.

  • DIDDLE, AW (1949 Jan). "Endometrial carcinoma". Western journal of surgery, obstetrics, and gynecology. 57 (1): 20–2. PMID 18107274. {{cite journal}}: Check date values in: |date= (help)
  • ARNESON, AN (1950 Aug). "The use of radium in the treatment of endometrial cancer". The Journal of the Kansas Medical Society. 51 (8 Suppl.): 37A – 38A. PMID 14774594. {{cite journal}}: Check date values in: |date= (help)
  • SPEERT, H (1949 Mar). "Carcinoma of the endometrium in young women". Surgery, gynecology & obstetrics. 88 (3): 332–6. PMID 18111780. {{cite journal}}: Check date values in: |date= (help)

Blue Rasberry (talk) 17:59, 19 September 2014 (UTC)[reply]

I imagine there was very little "popular discussion" until recent decades (or even now), because of the "delicate" location, and it would probably be lumped with other female repro system cancers. Like the pancreas, the endometrium is not one of the bits of internal anatomy that most people know about, or can name (a smaller group than one might think, it seems). I agree some medical history would be good. Wiki CRUK John (talk) 10:28, 22 September 2014 (UTC)[reply]
Indeed, just today in The Guardian: "Womb cancer: the most common diagnosis you’ve never heard of". Wiki CRUK John (talk) 12:31, 22 September 2014 (UTC)[reply]
@Bluerasberry:/@Wiki CRUK John: I'm taking an immunology exam this week (eek!) so it may take me a couple days but I'll read through these articles and see if I can come up with anything beyond "nobody talks about this". Watch this space! :) Keilana|Parlez ici 04:23, 23 September 2014 (UTC)[reply]
@Bluerasberry:/@Wiki CRUK John: Okay. Immunology exam survived. It turns out that I don't have access to these articles either. I've looked at the Guardian article and incorporated a brief history and culture section. I think John is right - there's not much discussion because it's in the uterus and it's in a relatively obscure bit of anatomy. I can't find anything more to add to a history and culture section - I hope it's adequate. Keilana|Parlez ici 15:53, 29 September 2014 (UTC)[reply]
Keilana We checked for sources and Wikipedia is a summary of what we have found. I am happy with the outcome and think that the culture section presents what identified reliable sources have to say. Thanks. Blue Rasberry (talk) 16:10, 29 September 2014 (UTC)[reply]

Comments by Cas Liber

[edit]
  • I'll copyedit anything straightforward and drop some notes as I go....
Other possible symptoms include: pain with urination, pain with sexual intercourse or pelvic pain - it's alotta pain in one sentence...why not "Other possible symptoms include: pain with urination or sexual intercourse, or pelvic pain"
Done
It most commonly occurs in the decades after menopause - looks weird without a number before "decades"....
I'm not sure what number I could put there, suggestions? Keilana|Parlez ici 16:01, 29 September 2014 (UTC)[reply]
Hmmm, if it can't b quantified, do we lose any meaning by "It most commonly occurs in the decades after menopause"?
Endometrial cancer is associated with obesity, excessive estrogen exposure, high blood pressure and diabetes.[1] Approximately 40% of cases are related to obesity.[4] - I'd flip these, which allows some elimination of repetition - "Approximately 40% of cases are related to obesity.[4] Endometrial cancer is also associated with excessive estrogen exposure, high blood pressure and diabetes.[1] "
Done
Immigration studies show that there is some environmental component to endometrial cancer. - looks interesting - any other comments from the article that can be gleaned on the basis for this would be good to add at this point.
Unfortunately, it's a gyne textbook and doesn't say much beyond that. Will add more if I come across anything. Keilana|Parlez ici 16:01, 29 September 2014 (UTC)[reply]
Endometrial cancer nearly always develops before colon cancer, on average, 11 years before - would be better further up its para.
Done
Endometrial cancer forms when normal cell growth in the endometrium encounters errors. - "encounters" strikes me as an odd word here..."errors arise in cell growth..."? Actually, try reading the para without the sentence as I think we can lose it and not lose meaning
Hrm, I was trying to avoid saying "goes wrong". How's "Endometrial cancer forms when there are errors in normal endometrial cell growth"? Keilana|Parlez ici 16:01, 29 September 2014 (UTC)[reply]
Better, though I still think we could actually lose the sentence altogether. Cas Liber (talk · contribs) 21:32, 29 September 2014 (UTC)[reply]
Lymphadenectomy is routinely performed for all stages of endometrial cancer in the United States, but in the United Kingdom, the lymph nodes are typically only removed with disease of stage II or greater - this contrasts oddly with the sentence immediately before it. In fact, I'd put The topic of lymphadenectomy and what survival benefit it offers in stage I disease is still being debated. as the first sentence in the bit discussing who does what and probably lose the above sentence.
This came up earlier - it's histologic grade vs stage. I don't want to avoid the stage difference between US and UK. To clarify - in both countries, any cancer above stage II OR grade II gets lymphadenectomy. The only difference is that in the US, stage I (not grade I) cancers also can have lymphadenectomy. I'm not sure how to make the wording clearer. Keilana|Parlez ici 16:07, 29 September 2014 (UTC)[reply]
sigh - this happens sometimes. Will take another look. Cas Liber (talk · contribs) 21:32, 29 September 2014 (UTC)[reply]
Laparotomy, an open-abdomen procedure, is the traditional surgical protocol; - strange way to use "protocol" - I'd say "Laparotomy (open surgery) is the traditional surgical procedure;" or somesuch.
Done
There are several experimental therapies for endometrial cancer under research as of the 2010s, including immunologic, hormonal, and chemotherapeutic. - I think you can lose the "as of the 2010s" -as implied and hence redundant
Done
can stop or reverse the progress of endometrial cancer in young women. - you'd want to qualify with an age limit or range other than "young".....
Not sure what "young" means beyond "pre-menopausal". The source isn't clear, unfortunately. Keilana|Parlez ici 16:07, 29 September 2014 (UTC)[reply]
Ok Cas Liber (talk · contribs) 21:32, 29 September 2014 (UTC)[reply]

Just looking at the overall coverage and balance...looks good though I haven't investigated sources as yet. My cousin is a OBGYN so will ask her to have a look. Cas Liber (talk · contribs) 20:43, 21 September 2014 (UTC)[reply]

@Casliber: Thank you so much for your review! Keilana|Parlez ici 16:07, 29 September 2014 (UTC)[reply]

Review by Jfdwolff

[edit]

 Done SUPPORT after the below points were addressed. JFW | T@lk 22:39, 18 October 2014 (UTC)[reply]

Firstly, well done on the hard work so far. Truly admirable and likely to have a real impact; the writing style is clear and accessible. I will keep my comments brief.

  •  Done General: a number of primary sources is referenced, and I was hoping they could be replaced with secondary sources (e.g. Mariño-Enríquez et al 2008, Nicolaije et al 2013)
I think these are okay because I only reference the portions that are the "review of the literature". If that's not okay, I can work on replacing them. Keilana|Parlez ici 16:14, 29 September 2014 (UTC)[reply]
Acceptable if there are no alternatives. JFW | T@lk 20:13, 11 October 2014 (UTC)[reply]
  •  Done The introduction has numerous references; I think they can be a bit offputting for the casual reader and I would recommend removing them.
  •  Done Signs and symptoms: in the second paragraph, the exact meaning of "these symptoms" is not quite clear. Does it refer to pyometra or to abdominal pain and cramping, and does it specifically indicate endometrial cancer or other cancers as well?
  •  Done Risk factors: many readers may not understand what an "immigration study" is, and a short explanation of its relevance would be beneficial.
  • Hopefully gave a fairly decent explanation.
  •  Done Risk factors#Genetics: I am unsure what is meant by "loose association" - is there an apparent link between BRCA1/2 and endometrial cancer that can be attributed to the use of tamoxifen? Clarification may be needed.
  •  Done Risk factors#Protective factors: is there any particular explanation why multiparity reduces the risk? Currently the context alludes to the possibility that it might be progestin-related.
  •  Done Pathophysiology: the text refers to "Type 1" and "Type 2" cancers, but they are only defined further down in the article (in Diagnosis#classification)
  •  Done Management#Surgery: the exact purpose of mastectomy in type 2 tumors is unclear ("prophylaxis" is vague)
  • So the source just says "For type II lesions, mastectomy is usually added." My assumption is that it's got something to do with estrogen receptors but I'm digging for a more comprehensive explanation. Keilana|Parlez ici 16:12, 8 October 2014 (UTC)[reply]
  •  Done Management#Add-on therapy#Radiotherapy: some short explanations of concepts like EBRT and brachytherapy would be valuable
  •  Done Management#Targeted therapy: if this is not in widespread use it might be better to move this to "Research"
  •  Done References: generally good sourcing. Some of the journals are linked to a redlink - is there a reason for this or might it be possible to remove them?

I am leaning strongly towards support, so please let me know when the above has been addressed! Good luck. JFW | T@lk 22:47, 23 September 2014 (UTC)[reply]

@Jfdwolff: I think I've addressed everything, would you be willing to take another look please? Thanks, Keilana|Parlez ici 21:08, 9 October 2014 (UTC)[reply]
Keilana Great work. Just a couple of loose ends but coming very close to full support. JFW | T@lk 20:13, 11 October 2014 (UTC)[reply]
@Jfdwolff: I think I've tied those up, thanks again! Best, Keilana|Parlez ici 18:20, 14 October 2014 (UTC)[reply]
@Keilana: Excellent work. SUPPORT for FA from me! JFW | T@lk 22:39, 18 October 2014 (UTC)[reply]
  • SUPPORT Agree excellent article. One comment is that I would either add redirects where appropriate or a small amount of content at the red links. This is simply a personal thing and is in no way required. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:52, 19 October 2014 (UTC)[reply]

Some suggestions from an ip collaborator

[edit]

First of all, I too would like to congratulate Keilana on her exemplary work here.

In the lead:

  • Endometrial cancer is when cancer arises from the endometrium... Personally, I'm uncomfortable with this structure on stylistic grounds. Suggest either Endometrial cancer is cancer that arises from the endometrium... or Endometrial cancer occurs when cancer arises from the endometrium...
  • It is due to the abnormal growth of cells that... The expression "due to" seems to imply that it is caused by abnormal growth (which at a cellular level is admittedly true). Suggest It stems from the abnormal growth of cells that...
  • Suggest While Whereas taking estrogen alone increases...
  • Suggest Between two and five percent of cancers cases are related to genes inherited from a the person's parents.

In the reference list:

tbc 109.153.156.71 (talk) 17:17, 9 October 2014 (UTC)[reply]

@109.153.156.71: (does ping work with IPs??) Thank you very much for your comments! I look forward to hearing more. Keilana|Parlez ici 21:16, 9 October 2014 (UTC)[reply]

Comments by WS

[edit]

Great article, seems to be very complete and almost ready to be a featured article. I have some concerns/comments:

  • The word 'should' is used far too often (women with endometrial cancer should...)
  • A lot of numbers and percentages are given, but it is not always exactly clear what they mean (e.g. the risk of endometrial cancer is 1.6%, is this annual risk? lifetime risk? in women only (presumably)? Also, assuming this is lifetime risk, it contradicts the 2-3% number given a few sentences below)
    Only in people with uteruses, yeah. Nothing in Pubmed on trans men and their risk of endometrial cancer, though I did find this and this, which say that trans men taking testosterone who haven't had a hysterectomy may be at higher risk. Keilana|Parlez ici 04:05, 14 October 2014 (UTC)[reply]
    Just to be clear, I was not sugesting including trans men in this, just adding 'in women' to that sentence would do. However the point on the numbers/percentages which are not always completely clear still stands. --WS (talk) 07:41, 14 October 2014 (UTC)[reply]
    Keliana, do you know whether that number accounts for the hysterectomy rate? I believe that something like a third to half of American women have a hysterectomy. When you're talking about older women, the gap between "1.6% of people who were born with a uterus" and "1.6% of people who still have a uterus" is about half a million American women. WhatamIdoing (talk) 23:06, 14 October 2014 (UTC)[reply]
    @Wouterstomp: and @WhatamIdoing: Okay, so I've been looking into this for the past few days and here's the deal. The first pair of numbers (0.6% vs 1.6%) is in women up to the age of 75 and doesn't mention the hysterectomy rate. I read the original paper and it didn't say anything about hysterectomies - I'd therefore assume "1.6% of people who were born with a uterus". The second number (2-3% lifetime risk) includes women after the age of 75 and also doesn't mention hysterectomies. I'm not sure these numbers are incompatible because they used different age ranges, and given that the average age of diagnosis is pretty high, the incidence after 75 could be skewing that number a bit. Keilana|Parlez ici 16:07, 17 October 2014 (UTC)[reply]
  • "Routine screening of asymptomatic women is not indicated, since the disease is highly curable in its early stages." - I would consider this a strong argument for rather than against screening; or is it meant to say early symptomatic stages?; also screening could have its own subsection.
Early symptomatic stages, it's usually symptomatic very very early on. Routine screening would pick it up about when someone would be noticing symptoms.
...and I don't think that would technically count as screening. 2c, 109.153.156.71 (talk) 18:46, 16 October 2014 (UTC)[reply]
I think what they're suggesting is, like, doing a Pipelle biopsy on women after menopause. Which would be ineffective because it would pick up cancer right around the stage when they'd be noticing the sx anyways. Keilana|Parlez ici 16:07, 17 October 2014 (UTC)[reply]
  • I would suggest starting the article with a classification section, and only keeping a few sentences about classification in the diagnosis section (especially considering the pathophysiology section discusses type I and II cancers without them having been defined before).
Just to clarify, do you want me to move the existing classification section to the beginning of the article, or add something about classification to the lead or something else? Keilana|Parlez ici 16:07, 17 October 2014 (UTC)[reply]
  • in the lead: "In 2012, endometrial cancers occurred in 320,000 women and caused 76,000 deaths." - Although these might be impressive numbers, risks/percentages would be more useful i.m.o.
I'm gonna hold off on that till we sort out what's up with the risk percentage stats. I'd also like to keep the incidence numbers in the lead if that's okay. Keilana|Parlez ici 16:07, 17 October 2014 (UTC)[reply]
  • "Alcohol consumption is associated with endometrial cancer, though the association has not been fully investigated and is not currently considered significant." - Not really sure how to interpret that, can this be left out?
Basically, some studies show an association with alcohol, but the studies aren't strong enough to say there's definitely a connection yet. I'm open to taking it out. Keilana|Parlez ici 04:05, 14 October 2014 (UTC)[reply]
  • The diagnosis section is a bit vague; it could use a short introduction indicating what the definite diagnosis is based on, and what role physical examination, imaging and histology have.
Okay, I've written some intro text. How's it look? Keilana|Parlez ici 16:07, 17 October 2014 (UTC)[reply]
  • The history section could be expanded; e.g. here you could mention when things like chemotherapy or hormonal therapy were widely introduced into clinical practive , instead of the somewhat vague definitions now used in the specific sections (e.g. "Adjuvant chemotherapy is a recent innovation")
Unfortunately, I'd have to end up delving into OR to write this properly, so that may be a future publication for me that we can then cite here. ;) Keilana|Parlez ici 04:05, 14 October 2014 (UTC)[reply]
  • The research section is quite long; is this all up-to-date information or merely the text that has accumulated over the years? I would generally prefer keeping it short and only indicating broad research directions being pursued instead of specifics.
This is all recent, compiled in the past month or two. Everything should be up to date and I'm committed to keeping it that way. Keilana|Parlez ici 04:05, 14 October 2014 (UTC)[reply]
Ok, that's great. --WS (talk) 07:41, 14 October 2014 (UTC)[reply]
  • The see also section can be removed I think.
Not sure what the rationale for the links there was, I've changed it to actually useful see also links. Keilana|Parlez ici 04:05, 14 October 2014 (UTC)[reply]
  • A lot of info is sourced to the Cochrane reviews. Although these are (very) high quality sources, they address a specific question, and I think they should be primarily used to support this topic, while more general information is more appropriately sourced to a good more general review article.
The parts I'm citing from the reviews are usually the review of literature bit, not necessarily the results bit. I can duplicate with a traditional review article if you'd like, though. Keilana|Parlez ici 04:05, 14 October 2014 (UTC)[reply]
This is perhaps more a matter of personal preference, the Cochrane reviews are certainly ok as well. --WS (talk) 07:41, 14 October 2014 (UTC)[reply]

I have made some further smaller changes myself. Support feature article candidacy once most of these points are resolved. --WS (talk) 22:33, 13 October 2014 (UTC)[reply]

@Wouterstomp: Thanks so much for your review! I really appreciate it. I've answered some above and will keep plugging away in the next few days. Best, Keilana|Parlez ici 04:05, 14 October 2014 (UTC)[reply]
@Wouterstomp: Okay, I think I've cleared most of these up. Would you mind taking another look? Thanks, Keilana|Parlez ici 16:07, 17 October 2014 (UTC)[reply]

@Wouterstomp: are you satisfied with the responses to you review? Graham Beards (talk) 09:29, 22 October 2014 (UTC)[reply]

Comments by Wiki CRUK John

[edit]
I've had a re-review at CRUK, as it's moved on a fair bit since the first, and will make most of the changes straight to the article, if that's ok. I'll come back with a diff here. It's pretty much all fine-tuning. Wiki CRUK John (talk) 13:12, 22 October 2014 (UTC)[reply]
  • One point echoing WS above is his "I would suggest starting the article with a classification section, and only keeping a few sentences about classification in the diagnosis section (especially considering the pathophysiology section discusses type I and II cancers without them having been defined before)." See also one of JFW's points, resolved by a "see below". WP:MEDMOS's list of recommended sections says:
      • The following list of suggested headings contains wikilinks; the actual headings should not.
        • Classification: If relevant. May also be placed as a subheading of diagnosis
      • Signs and symptoms or Characteristics ....

- but I think all the cancer articles I've looked at put "Classification" as a subheading of diagnosis, rather than at the start. I think this is often sub-optimal. As it now is, with sub-sections on several types, some pretty rate, I think it's too long to put it all at the top. But a summary just below the lead would be good. Wiki CRUK John (talk) 13:27, 22 October 2014 (UTC)[reply]

@Wiki CRUK John: Thanks for getting a re-review! I'm not sure what to call the shorter section other than "classification". perhaps "types"? I could do just one or two sentences on each subtype. What do you think? Keilana|Parlez ici 13:46, 22 October 2014 (UTC)[reply]
You could call the top one Classification & in diagnosis "types". I wouldn't even do one or two sentences on each subtype, just take up the "carcinoma" summary, & add a sentence on sarcomas. Also is the treatment generally the same-ish for all? Wiki CRUK John (talk) 14:01, 22 October 2014 (UTC)[reply]
Right, that's sorted then. That's a nifty solution I'll employ from here on out! Keilana|Parlez ici 00:58, 23 October 2014 (UTC)[reply]
  • "Alcohol consumption is associated with endometrial cancer, though the association has not been fully investigated and is not currently considered significant.ref name=WCR2014/" I can't see this in the expected place in the WCR - p. 475. Nor is EC in the list in the Alcohol risks chapter on p. 97 Table 2.3.1. CRUK don't think there's an association ("An analysis of studies has shown no link between drinking alcohol and the risk of womb cancer" on the site), & afai can see the papers by Saso, Columbo, Burke & their respective co-authors don't mention it. Hypertension might be added to the list of risk factors, per all 3 of those sources.
I may have mixed up or lost a citation somewhere in there? Not sure what happened. Hypertension is already in there, last sentence of #Other health problems. ("High blood pressure is also a risk factor,[16] but this may be because of its association with obesity.[20]", cited to Colombo and Burke). Keilana|Parlez ici 00:58, 23 October 2014 (UTC)[reply]
  • Refs :
4.^ Jump up to: a b c d e f g h i j k l m n o International Agency for Research on Cancer (2014). World Cancer Report 2014. World Health Organization. Chapter 6.7. ISBN 978-92-832-0429-9.
5.^ Jump up to: a b c d e f International Agency for Research on Cancer (2014). World Cancer Report 2014. World Health Organization. Chapter 5.12. ISBN 978-92-832-0429-9.

-Chapter 6.7 is economic burden, 5.12 is gyny cancers.

  • Staging (this is me) - shouldn't you cover how this is done? NB in particular the Burke source on the preference for surgical staging, reflected also in Saso et al (Bottom p 4). You have, refed Hoffman "Staging of the cancer is done during the surgery" in the surgery section, but this is not always the case - ie it may have been done before, but subject to revision after the operation. See also Burke p. 388 rt col etc.
So as far as I can tell, staging's usually done intraoperatively unless there's some reason not to operate. Burke says "Even with revisions of the staging system in 2009, total hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic and para-aortic lymph node dissection continue to be recommended." and Saso says "A meta-analysis of 47 studies that compared the usefulness of computed tomography, ultrasound, and MRI in staging of endometrial cancer found that contrast enhanced dynamic MRI was the most reliable method of identifying patients at high risk of tumour metastasis and presence of local lymphadenopathy." To me this implies that staging can only be completed during surgery and imaging is only preliminary. Keilana|Parlez ici 00:58, 23 October 2014 (UTC)[reply]
Oh, I see what you mean! Okay. Yeah. I've included that information in the staging section now. (The figure was 26% overall, btw - "GOG 33 found that 9% of patients who had clinically determined stage I disease had pelvic nodal metastases, 6% had para-aortic lymphadenopathy, 5% had spread to adnexa, and 6% had other extrauterine metastases at the time of surgery") Better? Keilana|Parlez ici 17:52, 23 October 2014 (UTC)[reply]
  • "Brachytherapy can also be used when there is a contraindication for hysterectomy" I couldn't actually find this bit in Colombo - no doubt there somewhere. Our reviewer agreed, but said EBRT was also used for this - both together, or either.
As in, brachytherapy is either used alone (when you can't do a hysterectomy) or as adjuvant therapy? Not sure what the issue is but I've had a brain-frying day... Keilana|Parlez ici 00:58, 23 October 2014 (UTC)[reply]
As in "Brachytherapy and EBRT can also be used, singly or in combination, when there is a contraindication for hysterectomy" Wiki CRUK John (talk) 09:23, 23 October 2014 (UTC)[reply]
Included that now, thanks. Keilana|Parlez ici 17:52, 23 October 2014 (UTC)[reply]
  • " "more common in Black women..." classification, also Black, White, Native Hawaiian etc capitalized in Epidemiology. Is this right by US standards?
That's how I've seen it, yeah. Keilana|Parlez ici 00:58, 23 October 2014 (UTC)[reply]
@Wiki CRUK John: Thanks for taking the time to do this! Responses above. Keilana|Parlez ici 00:58, 23 October 2014 (UTC)[reply]
All ok, except for the WCR ref name chapter as above. Wiki CRUK John (talk) 01:17, 24 October 2014 (UTC)[reply]
The above discussion is preserved as an archive. Please do not modify it. No further edits should be made to this page.
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