Abstract
Simple SummaryEndometrial cancer is the most common malignancy of the female genital tract, and in 14% of cases, is diagnosed in premenopausal women, While, the cancer appears in 5% in women of childbearing age. Preserving fertility in these women should be the goal of cancer practice. The aim of our study is to describe pregnancy outcomes of our center in women with G1 endometrial endometrioid cancer and atypical endometrial hyperplasia/endometrial intraepithelial neoplasm undergone conservative treatment. Moreover, for the first time, obstetric and oncological outcomes are described in a long follow up, including women with minimal myometrial infiltration.Endometrial cancer (EC) is the fourth largest female cancer in Europe and North America. In 5% of cases, the diagnosis is made in women who wish to become pregnant. In our retrospective study, we reported our experience about fertility sparing treatment of G1 endometrioid endometrial cancer (G1 EEC) or atypical endometrial hyperplasia/endometrial intraepithelial neoplasm (AEH/EIN) in young women desiring pregnancy treated in our Center. Conservative treatment was based on operative hysteroscopy and hormone therapy with megestrol acetate (160 mg/die for 9 months). For the first time we included women with G1 EEC with minimal myometrial infiltration. The minimum follow-up period was two years and consisted of serial outpatient hysteroscopies with endometrial biopsies. Among the 36 women with G1 EEC we observed one case of disease persistence and four recurrences and four recurrences among the 46 women diagnosed with AEH/EIN. To date, 35 live births were obtained in both groups. Our results advance the hypothesis that conservative treatment can represent a safe and feasible alternative to propose to young women with desire for pregnancy. Further randomized and multicentric studies are needed to arrive at unambiguous and standardized guidelines on the surgical and medical treatment of young women with EEC or AEH/EIN.
Highlights
Endometrial cancer (EC) is the most common cancer of the female genital tract and the fourth most frequent after breast, lung, and colorectal cancers in Europe and North America [1]
In this study we report our experience on the fertility sparing treatment of G1 endometrioid endometrial cancer (G1 EEC) and atypical endometrial hyperplasia/endometrial intraepithelial neoplasm (AEH/EIN) in young women wishing to become pregnant treated in our tertiary Center
After the initial counselling ten (21.7%) women with G1 EEC and nine (16.3%) women with AEH/EIN refused conservative treatment and underwent total hysterectomy with bilateral salpingectomy, due to the risks associated with the proposed treatment, the long and strict follow-up period and because some of these had already exhausted their desire for pregnancy
Summary
Endometrial cancer (EC) is the most common cancer of the female genital tract and the fourth most frequent after breast, lung, and colorectal cancers in Europe and North America [1] It is the fifth most common cancer in women, who have a 1% cumulative risk of developing the disease within. The incidence of endometrial cancer is rising with increasing life, due to its common association with post-menopausal age, 14% of cases are diagnosed in premenopausal women and 5% of whom are under 40 [3,4] In these young women, the majority of cases are endometrioid, focal, well-differentiated EC, limited to the endometrium or superficial myometrium which generally shows a good long-term prognosis [3,5]. Hysteroscopic resections accompanied by hormonal therapy for fertility-sparing treatment in young women with early-stage
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