A survey of French gynecologists’ knowledge and attitudes toward conservative treatment for fertility preservation in young patients with endometrial cancer

Abstract Background Endometrial cancer combining uterus didelphys is quite rare clinically which partially explains that there is no discussion about young patients’ fertility preservation and follow up of tumor outcome. Case presentation In this article, we report a case of unilateral endometrial carcinoma found in a young patient with uterus didelphys who was treated with high-efficiency progesterone due to unfinished child-bearing. During the follow-up, the affected uterine endometrium was not reversed by progesterone. So, the patient underwent the abdominal surgery with the left uterus and left fallopian tube resection. We performed three consecutive immunohistochemical studies of the contralateral uterine endometrium to verify the safety of preserving the contralateral uterus and its appendages which preserved her fertility. Conclusions Endometrial cancer occurring in patients with uterus didelphys is quite rare in child-bearing age. In this case report, we preserved the patient’s contralateral uterus based on patient’s strong needs and negative IHC analysis of the preserved side uterine endometrium. However, the tumor and fertility outcome require more follow-up.

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Fertility Preservation in Young Patients with Endometrial Cancer

World Journal of Oncology Research ◽

10.15379/2413-7308.2016.03.05 ◽

2016 ◽

Vol 3 ◽

pp. 36-39

Author(s):

Georgios Androutsopoulos

Keyword(s):

Endometrial Cancer ◽

Fertility Preservation ◽

Young Patients

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Prolonged Conservative Treatment of Endometrial Cancer Patients: More Than 1 Pregnancy Can Be Achieved

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e31820003de ◽

2011 ◽

Vol 21 (1) ◽

pp. 72-78 ◽

Cited By ~ 33

Author(s):

Tamar Perri ◽

Jacob Korach ◽

Walter H. Gotlieb ◽

Mario Beiner ◽

Dror Meirow ◽

...

Keyword(s):

Endometrial Cancer ◽

Conservative Treatment ◽

Early Stage ◽

Intrauterine Device ◽

Endometrial Adenocarcinoma ◽

Tertiary Care ◽

Young Patients ◽

High Recurrence Rate ◽

High Dose ◽

Endometrioid Adenocarcinoma

Background:Preserving reproductive function in young patients with early endometrial cancer is an accepted concept today. The safety and feasibility of long-term conservative treatment, allowing more than 1 pregnancy, remain to be ascertained.Methods:This study was a retrospective chart review of a 27 women with endometrioid adenocarcinoma of the endometrium, who were treated conservatively at 2 tertiary-care institutions. Treatment comprised oral high-dose progestins with or without a levonorgestrel-releasing intrauterine device. Endometrial biopsy was repeated every 2 to 3 months.Results:Over 7.8 to 412 months (median, 57.4 months), tumors regressed completely in 24 (89%) of 27 patients and partially in 2 patients, with 79% responding within 1 to 17 months. Of the complete responders, 15 (62%) of 24 had a recurrence; 4 underwent hysterectomy, and 11 underwent subsequent progestational treatment. All 11 responded, and 3 subsequently conceived. After 2 to 4 years, 5 patients again had a recurrence, of whom 3 underwent hysterectomy. Overall, 2 patients developed ovarian adenocarcinoma. All patients are currently disease-free. Conception occurred in 14 (51.8%) of 27 patients, in 5 more than once. There were 17 live births, and 2 patients are pregnant.Conclusions:According to our data, prolonged progestational therapy for early-stage endometrial adenocarcinoma, allowing women to conceive, is feasible and apparently does not alter clinical outcome. Patients should be advised of the high recurrence rate and possible concomitant ovarian malignancy.

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Endometriosis of the perianal region – epidemiology, diagnosis and treatment

Nowa Medycyna ◽

10.25121/nm.2018.25.4.192 ◽

2018 ◽

Vol 25 (4) ◽

Author(s):

Małgorzata Kołodziejczak ◽

Iwona Sudoł-Szopińska ◽

Małgorzata Siergiej

Keyword(s):

Conservative Treatment ◽

Histopathological Examination ◽

Transvaginal Ultrasound ◽

Young Patients ◽

Pain Syndrome ◽

Cervix Uteri ◽

Pelvic Pain Syndrome ◽

Hormonal Activity ◽

Childbearing Age ◽

Extensive Resection

Endometriosis is the presence of the uterine endometrium beyond the uterus. The disease usually affects women of childbearing age. Foci of endometriosis are mostly (in 95% of cases) located in the peritoneal cavity (cervix uteri, vaginal vault, vulva, urinary bladder, inguinofemoral region) and only rarely found beyond it. Occasionally, endometriosis is found in the perineal tissues, usually in the episiotomy scar, and, exceptionally rarely, in the anorectal region. Endometriosis usually develops in the period of hormonal activity. The disease may be asymptomatic or manifest with dyspareunia, pelvic pain syndrome, fertility problems, menstrual disorders and heavy menstruation. The diagnosis of anorectal endometriosis is established through a thorough interview and additional tests, including transrectal and transvaginal ultrasound or optionally magnetic resonance imaging. The final diagnosis is determined in a histopathological examination, usually of samples collected intraoperatively. Also, an endoscopic examination should be performed (at least rectoscopy) to rule out other pathological lesions. Treatment includes pharmacotherapy and surgery. In young patients, in the period of hormonal activity, extensive resection with primary sphincter reconstruction seems to be the most optimal option. In older patients, nearing menopause, conservative treatment is a better solution as endometriosis regresses and disease symptoms subside after menopause. In these cases, conservative treatment helps avoid iatrogenic sphincter injury and faecal incontinence.

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Genomic Consideration in Chemotherapy-Induced Ovarian Damage and Fertility Preservation

Genes ◽

10.3390/genes12101525 ◽

2021 ◽

Vol 12 (10) ◽

pp. 1525

Author(s):

Seongmin Kim ◽

Sanghoon Lee ◽

Hyun-Tae Park ◽

Jae-Yun Song ◽

Tak Kim

Keyword(s):

Fertility Preservation ◽

Quality Care ◽

Young Patients ◽

Young Female ◽

Patients With Cancer ◽

Female Cancer Patients ◽

Ovarian Damage ◽

Prevention Methods ◽

Gonadal Damage ◽

Gene Alterations

Chemotherapy-induced ovarian damage and fertility preservation in young patients with cancer are emerging disciplines. The mechanism of treatment-related gonadal damage provides important information for targeting prevention methods. The genomic aspects of ovarian damage after chemotherapy are not fully understood. Several studies have demonstrated that gene alterations related to follicular apoptosis or accelerated follicle activation are related to ovarian insufficiency and susceptibility to ovarian damage following chemotherapy. This may accelerate follicular apoptosis and follicle reservoir utilization and damage the ovarian stroma via multiple molecular reactions after chemotherapy. This review highlights the importance of genomic considerations in chemotherapy-induced ovarian damage and multidisciplinary oncofertility strategies for providing high-quality care to young female cancer patients.

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Evaluation of Reproductive Concerns and Biographical Impact of Breast Cancer in Young Patients

Breast Care ◽

10.1159/000481340 ◽

2018 ◽

Vol 13 (2) ◽

pp. 124-128 ◽

Cited By ~ 1

Author(s):

Maximiliane Burgmann ◽

Kerstin Hermelink ◽

Alex Farr ◽

Friederike van Meegen ◽

Annika Heiduschk ◽

...

Keyword(s):

Breast Cancer ◽

Genetic Testing ◽

Fertility Preservation ◽

Young Patients ◽

Initial Decision ◽

Time Period ◽

Partnership Status ◽

Reproductive Concerns ◽

Young Breast Cancer ◽

Testing And Counseling

Background: This study evaluates interventions offered to young breast cancer (BC) patients, including fertility preservation, genetic testing, and counseling for parenthood concerns, and analyzes the effect of BC on biographical issues. Methods: Women who were diagnosed with BC at the age of 18-40 years and who underwent treatment at the Breast Center, Ludwig-Maximilian University (LMU) in Munich between 2006 and 2013, were eligible for this study. Patients received a self-developed questionnaire which covered the following topics: fertility preservation, family planning, genetic testing, parenthood concerns and children's needs, partnership status, and employment situation. Results: Re-evaluating their initial decision on fertility preservation, 76.4% of patients reported satisfaction with their decision. After BC diagnosis, 45.8% reported to have maternal desire, but only 21.7% actually planned to have children. 41.7% of patients missed sufficient counseling regarding parenthood concerns. Analysis of individual employment situations showed that the time period until the return to work was longer in patients who received chemotherapy. The majority of patients (71.6%) did not report changes in their partnership status. Conclusion: Young BC survivors report a lack of communication related to parenthood concerns and future conception, but are satisfied with counseling regarding fertility preservation and genetics.

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O-180 Oocyte vitrification for fertility preservation does not delay the initiation of neoadjuvant chemotherapy for breast cancer

Human Reproduction ◽

10.1093/humrep/deab127.081 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

I Sellami ◽

M Grynberg ◽

A Benoit ◽

C Sifer ◽

A Mayeur ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Cancer Patients ◽

Fertility Preservation ◽

Cancer Diagnosis ◽

Ovarian Tissue ◽

Young Patients ◽

Oocyte Retrieval ◽

Breast Cancer Patients ◽

Oocyte Vitrification

Abstract Study question Does oocyte vitrification for fertility preservation (FP) delay the initiation of neoadjuvant chemotherapy for breast cancer? Summary answer The indication of neoadjuvant chemotherapy for breast cancer should not be considered as an impediment to urgent oocyte vitrification for FP. What is known already FP is considered as one of the most important issues to address for young breast cancer patients. Cryopreservation of oocytes or embryos may be considered after controlled ovarian hyperstimulation (COH) or in vitro maturation (IVM). Pregnancies have been reported after reutilization of oocytes frozen following both procedures. Although oocyte competence is better after COH, this strategy requires on average 13 days to be achieved. In addition, the safety of ovarian stimulation before tumor removal is currently not formally established. In case of neoadjuvant chemotherapy, the risk-benefit balance of COH is not well known. Study design, size, duration Retrospective cohort study including all breast cancer patients eligible for oocyte vitrification following COH or IVM before initiation of neoadjuvant chemotherapy between January 2016 and December 2020. Participants/materials, setting, methods Inclusion criteria were: female patients with confirmed non metastatic breast cancer, 18 to 40 years of age, with indication of neoadjuvant chemotherapy, who have had oocyte retrieval for FP after COH or IVM +/- cryopreservation of ovarian tissue. Various time-points related to cancer diagnosis, FP or chemotherapy were obtained from medical record review. Main results and the role of chance A total of 198 patients with confirmed breast cancer who had oocyte retrieval following COH (n = 57) or IVM +/- cryopreservation of ovarian tissue (n = 141) for FP prior to neoadjuvant chemotherapy were included. Although women in IVM group were significantly younger as compared to patients who underwent COH (31.7 ± 4.2 vs. 33.3 ± 4.0 years, p = 0.019), ovarian reserve parameters, BMI and cancer stage did not differ between the two groups. Overall, the average time from cancer diagnosis to chemotherapy start was similar between patients having undergone COH or IVM before oocyte vitrification (37.3 ± 13.8 vs. 36.9 ±13.5 days in COH and IVM groups respectively, p=0.857). Limitations, reasons for caution The time from referral to FP consultation may have influenced the type of FP. In addition, the retrospective nature of the present analysis may constitute a limitation. Moreover, the efficiency and security of the different FP strategies used has not been analysed. Wider implications of the findings Oocyte vitrification following COH or IVM was not associated with delayed breast cancer treatment in the neoadjuvant setting, so long as there was a prompt FP referral. Young patients undergoing neoadjuvant chemotherapy should be informed of these findings to avoid unnecessary anxiety due to concern for delays. Trial registration number Not applicable

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New Variant Of Hormonal Treatment For Atypical Endometrial Hyperplasia And An Early Endometrial Cancer With Fertility Preservation

Онкогинекология ◽

10.52313/22278710_2019_1_36 ◽

2019 ◽

pp. 36-45

Author(s):

Olga V. Novikova ◽

Cholpon A. Avasova ◽

Elena G. Novikova ◽

Ksenia V. Krasnopolskaya ◽

Yulia A. Lozovaya ◽

...

Keyword(s):

Endometrial Cancer ◽

Fertility Preservation ◽

Endometrial Hyperplasia ◽

Hormonal Treatment ◽

Atypical Endometrial Hyperplasia ◽

New Variant

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Leczenie zachowawcze torbieli korzeniowej – opis przypadku

Nowa Stomatologia ◽

10.25121/ns.2020.25.2.50 ◽

2020 ◽

Vol 25 (2) ◽

Author(s):

Sylwia Kuderewska ◽

Elżbieta Łuczaj-Cepowicz ◽

Grażyna Marczuk-Kolada

Keyword(s):

Conservative Treatment ◽

Surgical Procedures ◽

Root Canal ◽

Young Patients ◽

Complete Healing ◽

Radiographic Examination ◽

Radicular Cyst ◽

Tooth Crown ◽

Periapical Lesion ◽

Radiolucent Lesion

Radicular cyst is the most common odontogenic cyst. This condition can be asomptymatic, it may be accidentally detected on radiographs. Among the treatment methods we distinct conservative, surgical and conservative-surgical procedures. This article presents the case of a 15-year old male patient. He was reported to endodontic treatment of tooth 22 with extensive periapical lesion. Intraoral examination showed a change in the colour of the tooth crown, negative reaction to ethyl chloride, palpable slight excessive growth around the root of the tooth 22 and positive Smreker’s test. The radiographic examination showed the presence of a large 11 x 10 mm diameter radiolucent lesion covering 2/3 of the root lenght of tooth 22. Antiseptic root canal treatment was used. Complete healing of the periapical lesion was observed after 9-months treatment. Conservative treatment of root cysts, especially in young patients, may lead to complete healing of the lesion, which will allow to avoid the need for surgery intervention or at least reduce its extent.

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