Endometrial Carcinoma In Young Women Research Articles

Fertility-preserving treatment of stage IA, well-differentiated endometrial carcinoma in young women with hysteroscopic resection and high-dose progesterone therapy

ObjectiveThe standard treatment for endometrial cancer is surgery with hysterectomy. However, this procedure will cause infertility in young women who desire to preserve pregnant ability. Conservative management with hormone therapy has been shown to be satisfactory in both tumor control and fertility preservation. Recently, hysteroscopic tumor resection followed by progestin therapy has been reported to be an alternative strategy. In this study we present our experience with this approach. Materials and methodsSix young patients (30–36 years old) diagnosed with grade 1 stage IA endometrial cancer who wished to preserve fertility were enrolled for this treatment procedure. The patients underwent hysteroscopic tumor resection followed by oral progestin therapy with either megestrol acetate or medroxyprogesterone acetate for at least 6 months. Interval hysteroscopy with biopsy was performed during the treatment course to evaluate disease response. ResultsAll of the six patients had complete tumor remission after hysteroscopic resection and progestin therapy (five in 6 months, one in 9 months). In a median follow-up of 32 months (range 4–49months), one patient became pregnant spontaneously and delivered a full-term healthy baby via cesarean section. She received a definite surgery 3 months later, and the pathology confirmed no tumor existence. The other five patients were also free of disease at the last follow-up. ConclusionHysteroscopic tumor resection followed by progestin therapy for early-stage and well-differentiated endometrial cancer is a safe conservative treatment strategy. It could be an option for young patients who wish to preserve fertility.

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)

Analysis of endometrial carcinoma in young women at a high-volume cancer center

ObjectiveTo investigate the clinicopathological characteristics, treatment, survival, and prognosis of endometrial cancer in women aged ≤40 years. MethodsWomen who underwent surgery for endometrial cancer at a single high-volume cancer center between January 1995 and December 2014 were retrospectively reviewed. Women aged >40, patients with missing data, and those who did not undergo surgical staging were excluded. Univariate and multivariate regression models were used to identify the risk factors for overall survival and progression-free survival. ResultsA total of 40 patients with endometrial cancer were assessed. The median age at diagnosis was 38 (range, 21–40) years, and most of the uterine tumors found were early-stage (85%), low-grade (67.5%), and endometrioid carcinomas (97.5%). The median serum cancer antigen 125 level was 10.9 IU/mL (range, 3–1284 IU/mL). Optimal cytoreductive surgery was achieved in 35 patients (87.5%). All patients underwent total abdominal hysterectomy, and 97.5% of the patients underwent hysterectomy plus bilateral salpingo-oophorectomy. Among the total group of 40 patients, 21 (52.5%) underwent pelvic and para-aortic lymph node dissection, and 15 (37.5%) underwent only pelvic lymph node dissection. Multivariate analysis confirmed that a cancer antigen 125 level ≥35 was the only independent prognostic factor for both progression-free survival (hazard ratio, 22.997; 95% confidence interval, 1.783–296.536; p = 0.016) and overall survival (hazard ratio, 22.541; 95% confidence interval, 1.75–290.364; p = 0,017). ConclusionsOur study demonstrated that a cancer antigen 125 level ≥ 35 is the only independent prognostic factor for both progression-free survival and overall survival in patients aged ≤40 years with endometrial cancer.

Predictability of later developed relapse in endometrial carcinoma in young women with functional imaging parameters of fes/FDG SUV ratio after fertility-sparing hormone treatment.

e16502 Background: Even in responders of fertility-sparing hormone treatment for uterine endometrial carcinoma (EC) and atypical endometrial hyperplasia (AH) in young women, there have been high potential risks of later developed relapse. The aim of this study was whether changes in FDG and fluoroestradiol (FES) PET parameters following hormone treatment have the prognostic factor in prediction of later developed relapse. Methods: Eight young patients with EC and AH were treated by fertility-sparing treatment with a high-dose of medroxyprogesterone acetate (MPA) for 26 weeks. All patients underwent two FDG and FES-PET scans at baseline and 8 weeks after the beginning of MPA treatment, respectively. For each lesion, metabolic indices were calculated by standardized uptake values (SUV). All patients were followed up for 2 years. Values of FDG-SUV, FES-SUV and FES/FDG SUV ratio of tumors were retrospectively reviewed. The correlation between these parameters and clinical outcome of EC and AH for 2 years was evaluated. Results: An initial complete response was achieved in all patients. Two of 5 responders (40%) with AH and one of three (33%) responders with EC later developed (72-88weeks) relapse. One of those three patients underwent hysterectomy due to no response for additional MPA therapy. The tracer uptake of FDG and FES was decrease in all eight patients after 8 weeks. The FES/FDG ratio was increased in all three patients with later developed relapse, but the FES/FDG ratio was decrease in all patients without recurrence for 8 weeks. There was a significant difference of the change in FES/FDG ratio between later developed relapse patients and no relapse patients (0.113 vs -0.392; p = 0.044). Conclusions: This study suggests that an increase in the FES/FDG ratio after 8 weeks fertility-sparing hormone treatment with a high-dose of MPA may be a useful biomarker for predicting later developed relapse in EC and AH in young women.

Progestin intrauterine device and GnRH analogue for uterus-sparing treatment of endometrial precancers and well-differentiated early endometrial carcinoma in young women

BackgroundTo test the efficacy of levonorgestrel-release intrauterine device (LNG-IUD) plus gonadotropin-releasing hormone (GnRH) for treating women aged <40 years with atypical endometrial hyperplasia (AEH) or presumed International Federation of Gynecology and Obstetrics stage IA limited to the endometrium, well differentiated (G1), endometrioid endometrial cancer (EC), who wish to preserve their fertility. Patients and methodsA prospective observational study was conducted. Treatment consisted on the insertion of an LNG-IUD for 1 year plus GnRH analogue for 6 months. ResultsFrom January 1996 to June 2009, 20 and 14 patients with AEH and EC, respectively, were studied. Complete response rate was 95% in patients with AEH and 57.1% in women with EC-G1. A progression of the disease was observed in one (5%) and in four patients (28%) with AEH and EC, respectively. Four of 20 patients with AEH and 2 of 14 with EC-G1 experienced recurrences. The average relapse time was 36 months (range: 16–62 months). All of them were alive without evidence of disease at the last follow-up, mean: 29 months (range: 4–102 months). Nine women achieved 11 spontaneous pregnancies. ConclusionsThe combined treatment showed effectiveness in a substantial proportion of patients with AEH and EC. Close follow-up during and after treatment is crucial.

若年性子宮体がんの臨床病理細胞診断学的検討

目的 : 若年性子宮体がんは一般に早期がん, 高分化型類内膜腺癌の頻度が高いとされている. 若年性子宮体がんの病理細胞診断学的特徴を明らかにし, その特徴をもとに若年性子宮体がん早期発見の手がかりを見付けることを目的とした.方法 : 2000 年 1 月∼2006 年 12 月の 7 年間に当院で治療した 39 歳以下の子宮体がん (39 歳以下群) 48 例を対象とし, 病理細胞診断学的特徴について, 40 歳以上の子宮体がん (40 歳以上群) 671 例と後方視的に比較検討した.成績 : 病理組織学的特徴として, 両群ともに類内膜腺癌 Grade 1 の頻度が高く, 扁平上皮への分化を伴う類内膜腺癌の頻度は 39 歳以下群が 40 歳以上群に比較して有意に高かった (31.3% vs 17.6% (p=0.033)). 細胞診断学的特徴として, 扁平上皮への分化を伴う所見の割合は 39 歳以下群が 40 歳以上群に比較して有意に高かった (34.9% vs 9.4% (p<0.001)).結論 : 若年者の内膜細胞診において扁平上皮への分化を伴う異型内膜細胞を認めた場合は, 子宮内膜癌の存在に留意し, 病理組織検査を実施する必要があると考えられた.

Clinicopathologic study of uterine endometrial carcinoma in young women aged 40 years and younger

To clarify what constitutes the adequate management of uterine endometrial carcinoma in young women, we reviewed clinicopathologically 31 patients aged 40 years and younger between January 1991 and June 2004. As a primary treatment, 12 cases chose hormonal treatment with medroxyprogesterone acetate (MPA; 600 mg/day) due to no findings of myometrial invasion and diagnosis of a grade 1, well-differentiated adenocarcinoma. In remaining 19 cases, surgery was performed. All the 19 patients who received surgery as a primary treatment are alive, with no evidence of a recurrence of the disease. In the 12 patients who received hormonal treatment, 8 patients eventually received a hysterectomy because of recurrence or no response to MPA. Of these eight patients, myometrial invasion was recognized in three patients. One of the eight patients died of the metastasized disease to the liver and brain after hysterectomy. After hormonal treatment, 4 of the 12 patients were exempted from surgery and showed no evidence of recurrence. Two patients had viable children. Progesterone receptor was negative in one case that died. Careful consideration should be given to hormonal treatment with MPA for the conservative management of endometrial carcinoma in young women. Moreover, MPA is not always a consistent management for every patient.

Clinicopathologic study of uterine endometrial carcinoma in young women aged 40 years and younger

To clarify what constitutes the adequate management of uterine endometrial carcinoma in young women, we reviewed clinicopathologically 31 patients aged 40 years and younger between January 1991 and June 2004. As a primary treatment, 12 cases chose hormonal treatment with medroxyprogesterone acetate (MPA; 600 mg/day) due to no findings of myometrial invasion and diagnosis of a grade 1, well-differentiated adenocarcinoma. In remaining 19 cases, surgery was performed. All the 19 patients who received surgery as a primary treatment are alive, with no evidence of a recurrence of the disease. In the 12 patients who received hormonal treatment, 8 patients eventually received a hysterectomy because of recurrence or no response to MPA. Of these eight patients, myometrial invasion was recognized in three patients. One of the eight patients died of the metastasized disease to the liver and brain after hysterectomy. After hormonal treatment, 4 of the 12 patients were exempted from surgery and showed no evidence of recurrence. Two patients had viable children. Progesterone receptor was negative in one case that died. Careful consideration should be given to hormonal treatment with MPA for the conservative management of endometrial carcinoma in young women. Moreover, MPA is not always a consistent management for every patient

Two Cases of Progressive Endometrial Carcinoma in Young Woman diagnosed by Laparoscopic Surgery

Two Cases of Progressive Endometrial Carcinoma in Young Woman diagnosed by Laparoscopic Surgery

Endometrial carcinoma in a 22-year-old virgin

This is a case report of a 22-year-old virgin woman complaining of heavy prolonged menstrual bleeding and with low serum iron levels and G6PD deficiency. Her hematological and biochemical indices were normal; however the ultrasound evaluation and computed tomograph findings revealed a bulky uterus with a thick central mass. The patient was prepared for a total abdominal hysterectomy and bilateral salpingo-oophorectomy but she opted for another hospital where she could preserve her reproductive organs. The definitive diagnosis was clinical stage iii and grade III endometrial carcinoma. Endometrial carcinoma in young women without known risk factors is aggressive. Its symptoms and ultrasound findings are nonspecific; thus tissue diagnosis is mandatory. However single and virgin patients pose a serious obstacle to endometrial curettage.

Conservative therapy for endometrial carcinoma in young women treated with repeated curettage and progestogen

Three women less than 35 years old, who wanted to preserve their fertility, were conservatively treated with repeated endometrial curettage and medroxyprogesterone acetate (600mg/d) for endometrial carcinoma. Treatments were given once a month for 6 to 8 months. No patient had evidence of recurrence for at least 16 months after the treatment, and 1 patient subsequently delivered 2 full-term babies. This conservative treatment by endometrial curettage with progestogens may be considered for young patients with early endometrial lesions who wish to preserve their fertility.

Conservative management of endometrial carcinoma with prolonged preservation of the uterus in a young patient

We report the case of a 30-year-old woman treated conservatively after the diagnosis of early, well-differentiated endometrial carcinoma. After diagnosis by means of Vabra aspiration, the patient was followed closely by means of repeat hysteroscopies, without evidence of recurrence. The patient conceived twice, 8 and 29 months respectively after initial diagnosis, and delivered vaginally two healthy infants. The patient remains alive with no evidence of disease and with preserved uterus 52 months after the first diagnosis of cancer. Conservative treatment of early, well-differentiated endometrial carcinoma in young women is feasible after adequate selection and full information to the patient. Hysterectomy after fullfillment of the wish of fertility remains a matter of discussion.

Endometrial carcinoma in young women. A clinical profile.

Endometrial carcinoma in young women. A clinical profile.