Endometrial Cancer In Young Women Research Articles

Endometrial carcinoma in patients under 40 years of age: insights from the Bulgarian Cancer Registry.

We aimed to investigate the overall survival (OS) of young women with endometrial cancer (EC) in Bulgaria and the impact of histological type on survival. This is a population-wide retrospective study of patients with EC (≤ 40 years at diagnosis) registered at Bulgarian National Cancer Registry (BNCR) between 1993 and 2020. Patients were re-classified according to the 8th edition of the TNM classification. In total, 30 597 patients were registered and histologically confirmed with malignant tumors of the uterine body. From that, 29 065 of them (95%) had ECs, and the rest had sarcomas. Around 1.64% of all malignant tumors of the uterine body are diagnosed in women under the age of 40. Most of them are diagnosed in the early stage. There was no significant difference in median OS for patients diagnosed before or after 2003. In recent years there was a slight improvement in survival and patients from the last cohort of this study had a 5-year survival rate of 92.5%. Patients with favorable pathology (T1, G1/2) had no lymph node involvement at the time of diagnosis and their 10-year survival rate was 94%. EC in young women is a rare disease. In most cases, patients are diagnosed in early stageT1, G1/2, N0 and their prognosis is excellent. However, the lack of improvement of OS of young patients with EC in the last three decades shows the need for treatment optimization.

Endometrial Cancer in Reproductive Age: Fertility-Sparing Approach and Reproductive Outcomes.

Endometrial cancer is the most common gynecologic malignancy in developed countries and approximately 7% of the women with endometrial cancer are below the age of 45. Management of endometrial cancer in young women who desire to maintain fertility presents a unique set of challenges since the standard surgical treatment based on hysterectomy and salpingo-oophorectomy is often not compatible with the patient's goals. A fertility-preserving approach can be considered in selected patients with early stage and low-grade endometrial cancer. An increasing amount of data suggest that oncologic outcomes are not compromised if a conservative approach is utilized with close monitoring until childbearing is completed. If a fertility-preserving approach is not possible, assisted reproductive technologies can assist patients in achieving their fertility goals.

Fertility sparing approach in young women with endometrial cancer

The incidence of endometrial cancer in young women is increasing, especially in developed countries. Although it is predominantly a disease of peri- and postmenopausal women, there is an absolute increase in younger women of childbearing age who, with today's lifestyle and pushing back maternal needs, do not have fulfilled reproductive plans. About 67% of cancers are diagnosed in the early stages. For these women, fertility-preserving procedures can be considered until reproductive plans are fulfilled. Subsequently, however, definitive management is appropriate even in the absence of carcinoma. This article discusses the most common gynecologic pelvic cancer, endometrial adenocarcinoma, and the possibility of fertility-preserving procedures.

Short and long-term outcomes of endometrial cancer and atypical endometrial hyperplasia management in young women

Objecitve: The incidence of endometrial cancer in young women is increasing. Since survival after management is in most cases excellent, the focus on long-term patient reported outcomes (PROs) is crucial. Herein we examine the characteristics and oncological and reproductive outcomes of young women with endometrial cancer. Methods: We have identified all women under 45 years of age treated at the University Medical Centre Maribor between the years 2008–2020. Women were contacted to evaluate the endometrial cancer specific PROs using the EORTC QLQ-EN24 questionnaire. Results: Endometrial cancer and atypical endometrial hyperplasia were diagnosed in women younger than 45 years in 5.1% women and in 5.3% women respectively. Fourteen women (44%) under 45 years were eligible for fertility sparing procedures and only 6 of them (43%) opted for this approach. Women who opted for fertility sparing procedures were significantly younger (p < 0.001) with a median age of 31.0 (29–35) versus 42.5 years (34–45) in women opting for standard treatment. A significant proportion of women opting for fertility sparing treatment (67%) were nulliparous (p < 0.014) at time of diagnosis. Considering PROs, a high level of reported back/pelvic pain and tingling/numbness in the limbs was reported in our group of women. Conclusions: Young women with endometrial cancer should be offered counselling on the possibility of fertility sparing procedures. Future research should focus on long term PROs and mechanisms of improving them.

Continued medical treatment for persistent early endometrial cancer in young women

ObjectiveWe aimed to investigate the effectiveness of continuing medical therapy in patients who did not achieve complete response (CR) despite 9 months of progestin treatment. We also sought to determine the prognostic factors associated with achieving CR among these patients. MethodsWe retrospectively analyzed 51 patients with presumed stage IA, grade 1 or 2 endometrioid adenocarcinoma who had persistent disease on biopsy performed at 9–12 months after at least 9 months of progestin-based therapy. Data on clinicopathological factors and oncological and obstetrical outcomes following continuous hormonal treatment were extracted from the patients' medical records and analyzed. Univariate and multivariate analyses for predicting CR were performed. ResultsThirty-seven (72.5%) of 51 patients achieved CR after prolonged fertility-sparing treatment. Median time to CR from starting initial progestin was 17.3 months (range, 12.1–91.7 months). On univariate analysis, history of polycystic ovarian syndrome, histologic grade 2, and not achieving partial response (PR) until 12 months were significantly associated with failure to CR (odds ratio [OR], 6.188, 95% confidence interval [CI], 1.405–27.244, p = 0.018; OR, 9.722, 95% CI, 1.614–58.581, p = 0.013; and OR, 21.750, 95% CI, 4.016–117.783, p < 0.001, respectively). Multivariate analysis revealed that not achieving PR until 12 months was an independent prognostic factor predicting failure to CR after prolonged progestin therapy (OR, 21.803, 95% CI, 3.601–132.025, p = 0.001). ConclusionsContinued medical treatment is effective for persistent early endometrial carcinoma after at least 9 months of progestin therapy in young women who want to preserve their fertility.

An ecological evaluation of the increasing incidence of endometrial cancer and the obesity epidemic

The prevalence of obesity has increased significantly in recent decades, particularly among younger women, and is a known risk factor for endometrial cancer. This study aimed to evaluate the trend in the prevalence of obesity and the incidence of type I endometrial cancer over time in various age categories to determine whether an ecological relationship exists. Data from the Surveillance, Epidemiology, and End Results Program and the National Health and Nutrition Examination Survey were used. The overall trend in the incidence of type 1 endometrial cancer and prevalence of obesity were observed over time from 1988 to 2016 and further categorized by age group (<45, 45-54, and ≥55 years). The prevalence of obesity has increased for all women, but most significantly for women younger than 45 years with a 16.3% increase among women aged 20 to 34 years and a 17.9% increase for women aged 35 to 44 years. The incidence of endometrial cancer has also increased across all age categories, and although it has increased in patients younger than 45 years by more than 14-fold (from <0.1 per 100,000 in 1988 to 1.4 per 100,000 in 2016), a more pronounced increase of 63-fold and 50-fold was observed among women aged 45 to 54 years (0.2 per 100,000 in 1988 to 12.6 per 100,000 in 2016) and women aged 55 years and older (from 0.6 per 100,000 in 1988 to 30 per 100,000 in 2016), respectively. The mean age of women diagnosed as having endometrial cancer also decreased from 64.1 years from 1988 to 1990 to 61.0 years from 2014 to2016. The prevalence of obesity has increased significantly in women of all ages. This increase, particularly among women aged <45 years, occurred simultaneously with an increase in the incidence of endometrial cancer in young women, with an even more pronounced increase among women aged ≥45 years.

Oncologic and pregnancy outcomes with fertility-sparing management for early-stage endometrial cancer in young women

Objective: The aim of this study is to evaluate the long-term oncologic and pregnancy outcomes of progestin treatment in young women with early-stage endometrial cancer who wish to preserve their fertility.

Characteristics and outcomes of endometrial cancer in young women: A SEER database analysis

Objective: Endometrial cancer incidence is rising; 9%–20% of women younger than 50 years will be diagnosed with endometrial cancer. Risk factors include obesity, chronic anovulation, and insulin resistance. Women younger than 50 years with endometrial cancer have more favorable histologies and earlier stage disease than women older than 50 years. Our objective was to analyze characteristics and outcomes of patients younger than 50 years diagnosed with stage 1 (local) versus stage 2–4 (metastatic) endometrial cancer.

Effectiveness and safety of continuing medical treatment for persistent early endometrial cancer in young women

Objective: Although standard treatment of endometrial cancer is hysterectomy, progestin therapy is an alternative treatment option for young patients who wish to preserve their fertility. According to current guidelines, hysterectomy with surgical staging is recommended if endometrial cancer is still present after 6 to 12 months of progestin-based therapy. In the clinical setting, if patients still want to preserve their fertility, continuing medical therapy can be considered. However, the feasibility of continuing medical treatment for nonresponders of progestin therapy has not been sufficiently established.

Endometrial cancer in young women: prognostic factors and treatment outcomes in women aged ≤40 years

ObjectiveEndometrial cancer in pre-menopausal patients aged ≤40 years is rare and poses both diagnostic and management challenges. The goal of this study was to investigate the clinical and pathologic factors...

Fertility sparing management of endometrial hyperplasia with atypia and grade 1 endometrial cancer in young women

Fertility sparing management of endometrial hyperplasia with atypia and grade 1 endometrial cancer in young women

Conservative treatment in early stage endometrial cancer: a review.

Endometrial Cancer (EC) is the commonest gynecological cancer and its incidence is increasing. The diagnosis of endometrial carcinoma in young women of childbearing age is rare. Indeed, only 4% of patients with endometrial carcinoma are <40 years of age. It’s typically diagnosed in postmenopausal women. The standard approach for the management of endometrial cancer in young women of childbearing age is hysterectomy and bilateral salpingo-oophorectomy with or without lymphadenectomy but is not ideal for women interested in future fertility. We reviewed the published literature to clarify in fertile women who have not yet fulfilled their desire for motherhood, what are the strategies, the risks of a conservative treatment of early stage of Endometrial Cancer and what are the obstetric outcomes in this patients. Recently, several studies have reported encouraging results on fertility-sparing management of EC with high dose of progestins in selected women associated or not with hysteroscopic resection. (www.actabiomedica.it)

Fertility-preserving treatment in complex atypical hyperplasia and early endometrial cancer in young women with oral progestin: Is it effective?

ObjectiveThe aim of this study is to assess the effectiveness of oral progestin treatment in women diagnosed with complex atypical hyperplasia (CAH) or grade 1 endometrial cancer (G1EC), who desire to preserve their fertility, as alternative treatment to a hysterectomy.MethodsWe reviewed the medical records of women younger than 45 years old that had been diagnosed with CAH or G1EC, who expressed a desire to preserve their fertility using alternative treatment at our institution. Women without evidence of myometrial invasion on pelvic magnetic resonance imaging scans were included. The study period was between 2004 and 2014. Endometrial biopsies were taken at follow-up appointments.ResultsWe identified 31 young women with CAH or G1EC. The median age was 33 years old (range, 20 to 41), and the median period of time undertaking the treatment was 5 months (range, 1 to 12). Twenty-three patients (74.2%) achieved complete remission (CR; median time to CR was 3 months; range, 1 to 22), 16 patients (88.9%) with CAH and 7 (53.8%) with G1EC achieved CR. 6 patients (26.1%) who had achieved CR, had recurrence of the disease (median time from CR to recurrence was 12.5 months; range, 4 to 18). Eight patients (25.8%) finally underwent a hysterectomy.ConclusionOral progestin therapy is an alternative treatment for women with CAH or G1EC who desire fertility preservation. However, more prospective studies are needed for standard progestin regimen. Also, there still remains a risk of disease progression and recurrence. Therefore, close follow-up is important during treatment and after CR. In addition, a hysterectomy is recommended as a definitive treatment after completion of childbearing.

Clinical and pathological characterization of endometrial cancer in young women: Identification of a cohort without classical risk factors

ObjectiveEndometrial cancer (EC) is the most common gynecologic malignancy with known risk factors including excess estrogen and hereditary syndromes. The objective of this study was to determine the proportion of young women with EC that could be attributed to these factors and if, as we suspected, there is a third population of young women in which neither factor is identifiable. We were interested in comparing clinicopathologic characteristics and outcomes across subgroups in order to better inform treatment recommendations. MethodsWe performed a retrospective chart review of women age 15–49 diagnosed with EC or complex atypical hyperplasia. Demographic, clinicopathologic, treatment, fertility, and outcome parameters were analyzed. ResultsOf 719 women identified, 327 were fully evaluable. 57.5% fit the “High Estrogen” risk criteria. 8.25% met criteria for suspected Lynch syndrome. 34.25% classified as “Neither” had no classical risk factors identified. There were no statistical differences in age, gravidity, tumor grade, treatment selection and response to hormonal therapy. Age of menarche, stage, histology, and synchronous ovarian cancer differed significantly. Prevalence of synchronous ovarian cancer was 21.0% of “Neither”, 23.1% of “Lynch”, and 6.6% of “High Estrogen”. For women who attempted pregnancy, 2/27 of “High Estrogen”, 0/3 of “Lynch”, and 2/16 of “Neither” achieved a live birth. ConclusionsThis study confirmed that a third population of young women with EC exist that lack classical risk factors and have distinct clinicopathologic parameters. No difference in success of conservative treatment or live births was noted in the small cohort in whom this treatment approach was attempted.

The Clinical Management of Endometrial Cancer in Young Women

Endometrial cancer (EC) remains the leading female genital tract malignancy in industrialized countries. Incidence rates are increasing in many Asia countries. A trend of increased fractions occurring in young women also has been observed. When fertility preservation is not a concern, standard surgical staging and tailored adjuvant therapy regardless of age should be practiced. High remission rates with subsequent pregnancies are seen in clinical stage IA without myometrial invasion and in grade 1 EC of young women using oral high-dose progestins as fertility-sparing treatment (FST), yet high recurrences and synchronous or metachronous ovarian malignancies should be cautioned. Intrauterine progestins seem efficacious but more investigations are needed. Aromatase inhibitors have limited data at present. Current selection criteria have been suboptimal for preserving uterine and/or ovary for young EC patients. Investigations on molecular profiles for selecting candidates for preserving ovary or FST and whether to do a consolidation hysterectomy are necessary.

Treatment with Medroxyprogesterone Acetate Plus Levonorgestrel-releasing Intrauterine System for Early-stage Endometrial Cancer in Young Women: Single-arm, Prospective Multicenter Study: Korean Gynecologic Oncology Group Study (KGOG2009)

A prospective multicenter trial has been started in Korea to investigate the treatment efficacy of a levonorgestrel-releasing intrauterine system plus medroxyprogesterone acetate in young women with early-stage endometrial cancer. A number of studies have reported the effectiveness of hormonal therapy using systemic progestin in women clinically diagnosed with early endometrial adenocarcinoma at Stage IA, Grade 1, who want to maintain reproductive potential. In addition, several recent studies reported the use of a levonorgestrel-releasing intrauterine system to treat patients at a high risk of perioperative complications who cannot tolerate systemic progesterone because of its adverse effects. However, there has been no prospective multicenter trial that investigated the effectiveness of treatment with systemic progesterone in combination with intrauterine progesterone in young women with endometrial cancer. Young patients with histologically confirmed Grade 1 endometrioid adenocarcinoma that is presumably confined to the endometrium, who desired to preserve their fertility potential, undergo levonorgestrel-releasing intrauterine system insertion and are administered medroxyprogesterone acetate at a dosage of 500 mg/day concurrently. The follow-up and treatment response assessment were implemented at a 3-month interval with office endometrial aspiration biopsy with the levonorgestrel-releasing intrauterine system in place, and dilatation and curettage after removal of the levonorgestrel-releasing intrauterine system. The primary endpoint is the complete response rate. The secondary endpoint is to estimate the consistency of the results of the office endometrial aspiration biopsy with the levonorgestrel-releasing intrauterine system in the uterus and a dilatation and curettage after removal of the levonorgestrel-releasing intrauterine system.

Etiology and Fertility Preservation Treatment for Young Women with Endometrial Cancer

Abstract Objective: The purpose of this review is to evaluate the risk factors for endometrial cancer in young women as well as fertility preservation options. Design: A literature search using the key words fertility preservation, endometrial cancer, uterine cancer, and risk factors was conducted in MEDLINE,® EMBASE, and the Cochrane Database of Systematic Reviews. Results: Etiologic factors for development of endometrial cancer were discussed. All available conservative options to avoid hysterectomy were also discussed. Treatment outcome for young women with endometrial cancer treated by systemic progestins was summarized. Conclusions: In women with early stage well-differentiated endometrial cancer, conservative treatment with progestins should be considered. It is important to note that this is a temporary treatment that has to be followed by a definitive treatment after completion of the patient's family. Proper counseling and close follow-up are mandatory. Because of the rarity of the disease in you...

Progestin Intrauterine Device in an Adolescent With Grade 2 Endometrial Cancer

The treatment of endometrial cancer in young women who desire future fertility poses several challenges. Oral progestin and progestin-releasing intrauterine devices (IUDs) have been shown to result in regression of endometrial hyperplasia and grade 1 endometrioid endometrial carcinoma. However, limited data are available on the use of these methods in women with grade 2 disease. An 18-year-old nulliparous woman was diagnosed with a grade 2 endometrial adenocarcinoma. She desired future fertility and therefore underwent placement of a levonorgestrel-releasing IUD. The patient subsequently underwent endometrial sampling every 3 months and remained disease-free 13 months after initial IUD placement. A progestin-releasing IUD may be a valid treatment option for grade 2 endometrial cancer in young women who desire to retain fertility.

Management of Endometrial Cancer in Young Women

Endometrial cancer is the most common gynecologic cancer and its incidence is rising among premenopausal women. Hysterectomy and bilateral salpingo-oophorectomy, traditional treatment for endometrial cancer, causes loss of fertility and ovarian function, both of which can significantly negatively impact a young woman's physical and mental well-being. Recently, conservative management with progestational agents has been reported with success from both oncologic and reproductive perspectives. However, there are no randomized trials comparing conservative versus surgical therapy. Patients who are candidates for conservative therapy must be extensively counseled regarding the risks and must comply with close surveillance.

The cases of Concurrent Chemo-Photodynamic therapy (CCPDT) for the uterine endometrial cancer in young women desiring fertility

The cases of Concurrent Chemo-Photodynamic therapy (CCPDT) for the uterine endometrial cancer in young women desiring fertility