II. Background

  1. DES is an oral synthetic nonsteroidal Estrogen
  2. DES was prescribed in pregnanc
    1. Used to improve pregnancy outcomes
    2. Later studies did not support any benefit for DES
    3. Used in U.S. 1938 to 1971
    4. Used in Europe until 1980's
  3. Now DES is only used in advanced Prostate Cancer

III. Associated conditions to DES Exposure (highly correlated)

  1. Associated with in utero exposure to DES
  2. Highest risk were patients exposed in first trimester
  3. Carcinoma
    1. Vaginal clear cell adenocarcinoma
      1. Peak onset age 17 to 22 years
      2. Possibly second peak at post-Menopause
    2. Breast Cancer (same risk as Hormone Replacement)
  4. Gynecologic tract abnormalities
    1. T-shaped Uterus
    2. Adenosis
    3. Cervical abnormalities (e.g. pseudopolyp)
  5. Risks in men exposed in utero to DES
    1. Undescended Testes
    2. Small Testes
    3. Possible Prostate Cancer risk
    4. Possible Testicular Cancer risk

IV. Surveillance of women with in utero DES Exposure history

  1. Colposcopy at first Pap Smear
    1. Repeat annually (at minimum) for abnormalities
    2. Routine Colposcopy not needed if normal
  2. Annual Pap Smear, four quadrants and pelvic exam
    1. Sample cells with brush from four vaginal quadrants
    2. Routine Pap Smear
    3. Bimanual exam
  3. Pregnancy management
    1. Discuss higher risk of Miscarriage and poor outcomes
    2. Refer to obstetrics if pregnant

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window

Cost: Medications

des (on 6/22/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
DESCOVY 200-25 MG TABLET $47.02 each
DESENEX 2% POWDER OTC $0.08 per gram
DESENEX 2% SPRAY POWDER OTC $0.04 per gram
DESIPRAMINE 10 MG TABLET Generic $0.81 each
DESIPRAMINE 100 MG TABLET Generic $2.99 each
DESIPRAMINE 25 MG TABLET Generic $1.03 each
DESIPRAMINE 50 MG TABLET Generic $2.12 each
DESLORATADINE 5 MG TABLET Generic $0.66 each
DESMOPRESSIN 0.01% SOLUTION Generic $19.66 per ml
DESMOPRESSIN 0.01% SPRAY Generic $19.66 per ml
DESMOPRESSIN 0.1 MG/ML SPRAY Generic $19.85 per ml
DESMOPRESSIN 10 MCG/0.1 ML SPR Generic $19.85 per ml
DESMOPRESSIN ACETATE 0.1 MG TB Generic $0.95 each
DESMOPRESSIN ACETATE 0.2 MG TB Generic $0.91 each
DESOGESTREL-ETHINYL ESTRAD TAB Generic $0.44 each
DESOGESTR-ETH ESTRAD ETH ESTRA Generic $0.89 each
DESONATE 0.05% GEL $7.65 per gram
DESONIDE 0.05% CREAM Generic $3.09 per gram
DESONIDE 0.05% LOTION Generic $3.03 per ml
DESONIDE 0.05% OINTMENT Generic $2.91 per gram
DESOXIMETASONE 0.05% CREAM Generic $4.88 per gram
DESOXIMETASONE 0.05% GEL Generic $3.78 per gram
DESOXIMETASONE 0.05% OINTMENT Generic $5.02 per gram
DESOXIMETASONE 0.25% CREAM Generic $1.81 per gram
DESOXIMETASONE 0.25% OINTMENT Generic $4.70 per gram
DESVENLAFAXINE ER 100 MG TAB Generic $4.02 each
DESVENLAFAXINE ER 50 MG TAB Generic $4.03 each

Ontology: Diethylstilbestrol (C0012203)

Definition (NCI) A synthetic, nonsteroidal form of estrogen. A well-known teratogen and carcinogen, diethylstilbestrol inhibits the hypothalamic-pituitary-gonadal axis, thereby blocking the testicular synthesis of testosterone, lowering plasma testosterone, and inducing a chemical castration.
Definition (NCI_NCI-GLOSS) A synthetic form of the hormone estrogen that was prescribed to pregnant women between about 1940 and 1971 because it was thought to prevent miscarriages. Diethylstilbestrol may increase the risk of uterine, ovarian, or breast cancer in women who took it. It also has been linked to an increased risk of clear cell carcinoma of the vagina or cervix in daughters exposed to diethylstilbestrol before birth.
Definition (MSH) A synthetic nonsteroidal estrogen used in the treatment of menopausal and postmenopausal disorders. It was also used formerly as a growth promoter in animals. According to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985), diethylstilbestrol has been listed as a known carcinogen. (Merck, 11th ed)
Definition (CSP) synthetic nonsteroidal estrogen used in the treatment of menopausal, postmenopausal, and other disorders sensitive to estrogens; an epigenetic carcinogen.
Definition (PDQ) DES; the acronym for diethylstilbestrol, a synthetic, nonsteroidal form of estrogen. A well-known teratogen and carcinogen, DES inhibits the hypothalamic-pituitary-gonadal axis, thereby blocking the testicular synthesis of testosterone, lowering plasma testosterone, and inducing a chemical castration. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=43081&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=43081&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C433" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109) , Hormone (T125)
MSH D004054
SnomedCT 396026002, 79332009, 326185006, 327252004
LNC LP18551-9, MTHU004623
English Stilbestrol, diethylstilbestrol, Phenol, 4,4'-(1,2-diethyl-1,2-ethenediyl)bis-, (E)-, Stilbestrol [gyn], Stilbestrol [malignancy], Stilboestrol [gyn], Stilboestrol [malignancy], Estrogen, Stilbene, 3,4-Bis(p-hydroxyphenyl)-3-hexene, 4,4'-Dihydroxy-alpha,beta-diethylstilbene, Alpha,alpha'-diethylstilbenediol, (E)-4,4'-(1,2-diethyl-1,2-ethenediyl)bisphenol, Trans-bis-(hydroxy-4-phenyl)-3,4 hexene-3, Stilbene Estrogen, stilbestrol, Diethylstilbestrolum, Diethylstilbenediol, Stilboestrol Dipropionate, Stilboestrol [gynaecological use], Stilbestrol [gynecological use], Diethylstilboestrol preparation, diethylstilbestrol (discontinued), diethylstilbestrol (discontinued) (medication), Diethylstilbestrol [Chemical/Ingredient], diethylstilbestrol (DES), Stilbestrol [gynecological use] (product), Diethylstilbestrol[malignancy], Stilbestrol [malignancy] (product), 3, 4-Bis(p-hydroxyphenyl)-3-hexene, DES, .alpha., .alpha.'-Diethylstilbenediol, Palestrol, 4,4'-Dihydroxy-.alpha., .beta.-diethylstilbene, 3-Hexene,3,4-bis(p-hydroxyphenyl)-, DES preparation, Diethylstilbestrol preparation, Stilbestrol preparation, Stilboestrol, Diethylstilbestrol (substance), Diethylstilbestrol preparation (product), Diethylstilboestrol, Stilboestrol preparation, Diethylstilbestrol preparation (substance), Stilbestrol [gynecological use] (substance), Stilbestrol [malignancy] (substance), Diethylstilbestrol [gynaecological use], DIETHYLSTILBESTROL, Diethylstilbestrol
Portuguese Estilbestrol, Dietilestilbestrol
Spanish Estilbestrol, dietilestilbestrol (producto), preparado de dietilestilbestrol (producto), preparado de dietilestilbestrol, estilbestrol [uso ginecológico], estilbestrol [uso oncológico], estilbestrol [uso oncológico] (producto), estilbestrol [uso ginecológico] (producto), dietilestilbestrol (sustancia), dietilestilbestrol, preparado de DES, preparado de dietilestilbestrol (sustancia), preparado de estilbestrol, Dietilestilbestrol
Swedish Dietylstilbestrol
Czech diethylstilbestrol
Finnish Dietyylistilbestroli
Italian Estrogeno dello stilbene, Stilbestrolo, Dietilstilbestrolo
Russian STIL'BESTROL, DIETILSTIL'BESTROL, ДИЭТИЛСТИЛЬБЭСТРОЛ, СТИЛЬБЭСТРОЛ
Croatian DIETILSTILBESTROL
Polish Dwuetylostilbestrol, Dietylostilbestrol, Stilbestrol
Japanese ジエチルスチルベストロール, エストロベン, スチルベストロール
French Diéthylstilbestrol
German Diethylstilbestrol, Stilben (Östrogen)

Ontology: prenatal fetal exposure to DES (C0149666)

Concepts Finding (T033)
English des exposure, prenatal exposure to diethylstilbestrol, prenatal fetal exposure to diethylstilbestrol, prenatal fetal exposure to DES