Conservative Surgery in Endometrial Cancer

Alessandra Gallo,Gabriele Saccone,Attilio Di Spiezio Sardo,Ursula Catena

doi:10.3390/jcm11010183

Abstract

Endometrial cancer (EC) is the sixth most common female cancer worldwide. The median age of diagnosis is 65 years. However, 4% of women diagnosed with EC are younger than 40 years old, and 70% of these women are nulliparous. These data highlight the importance of preserving fertility in these patients, at a time when the average age of the first pregnancy is significantly delayed and is now firmly established at over 30 years of age. National Comprehensive Cancer Network (NCCN guidelines state that the primary treatment of endometrial endometrioid carcinoma, limited to the uterus, is a total hysterectomy, bilateral salpingo-oophorectomy and surgical staging. Fertility-sparing treatment is not the standard of care, and patients eligible for this treatment always have to undergo strict counselling. Nowadays, a combined approach consisting of hysteroscopic resection, followed by oral or intrauterine-released progestins, has been reported to be an effective fertility-sparing option. Hysteroscopic resection followed by progestins achieved a complete response rate of 95.3% with a recurrence rate of 14.1%. The pregnancy rate in women undergoing fertility-sparing treatment is 47.8%, but rises to 93.3% when only considering women who tried to conceive during the study period. The aim of the present review is to provide a literature overview reflecting the current state of fertility-sparing options for the management of EC, specific criteria for considering such options, their limits, the implications for reproductive outcomes and the latest research trends in this direction.

Highlights

Endometrial cancer (EC) is the sixth most common female cancer worldwide, with approximately 417,000 new cases and 97,000 deaths in 2020 [1]
4% of women diagnosed with EC are younger than 40 years old; 70% of these women are nulliparous [2] or women whose reproductive desire has not yet been fulfilled at the time of diagnosis
EC develops as the evolution of endometrial hyperplasia, a cancer precursor lesion that is differentiated into two categories, according to the latest classification system of the World Health Organization (WHO), which in 2014 developed an update of the old system, classifying these lesions into “non-atypical hyperplasia” and “atypical hyperplasia or endometrioid intraepithelial neoplasia (EIN)”

Summary

Introduction

Endometrial cancer (EC) is the sixth most common female cancer worldwide, with approximately 417,000 new cases and 97,000 deaths in 2020 [1]. 4% of women diagnosed with EC are younger than 40 years old; 70% of these women are nulliparous [2] or women whose reproductive desire has not yet been fulfilled at the time of diagnosis These young patients (40 years old or less) have excellent 5-year survival rates, over 95%, as these women are more likely to present with endometrioid, focal, well-differentiated tumors, limited to the endometrium or superficial myometrium [3]; in other words, 80% of cases are early EC, stage IA, according to the International Federation of Gynecology and Obstetrics [FIGO] staging system. These data highlight the importance of preserving fertility in these women, at a time when the average age of the first pregnancy is significantly delayed and is firmly established at over 30 years of age

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