scholarly journals Fertility-Sparing Methods in Adolescents Affected by Endometrial Cancer: A Comprehensive Review

2021 ◽  
Vol 10 (5) ◽  
pp. 1020
Author(s):  
Krzysztof Gałczyński ◽  
Piotr Olcha ◽  
Katarzyna Romanek-Piva ◽  
Maciej Jóźwik ◽  
Andrzej Semczuk
Keyword(s):  
Endometrial Cancer ◽  
World Literature ◽  
Young Patients ◽  
Developed Countries ◽  
Type I ◽  
Genetic Syndromes ◽  
Patient Death ◽  
Future Fertility ◽  
Fertility Sparing

Although in developed countries endometrial cancer (EC) is the most common gynecological malignancy, its occurrence in adolescents is exceedingly rare. The increasing rate of obesity in children and adolescents is held responsible for the increasing prevalence of EC in younger cohorts of patients. The diagnosis of this malignancy can have devastating consequences for future fertility because standard treatment protocols for EC include hysterectomy. Here, we present the first detailed review of the world literature on EC in subjects aged 21 years or younger (n = 19). The mean age at diagnosis was 16.7 ± 0.6 years. One patient (5.3%) had a Type II (high-risk) disease. No communication retrieved from the search reported on patient death; however, two (10.5%) patients were lost to follow-up. There was also a high proportion (five subjects, or 26.3%) of cases with genetic background (Cowden syndrome and Turner syndrome), therefore genetic screening or a direct genetic study should be considered in very young patients with EC. The current fertility-sparing options, limited to Type I (low-risk) disease, are presented and discussed. Such information, obtained from studies on older women, translates well to adolescent girls and very young women. Careful anatomopathological monitoring at follow-up is essential for the safety of a conservative approach. Improved survival in very young EC patients makes the preservation of fertility a central survivorship issue, therefore both patients and caregivers should undergo counseling regarding available options. Moreover, our study suggests that genetic syndromes other than Lynch syndrome may be associated with EC more frequently than previously thought.

scholarly journals The Perspectives of Fertility Preservation in Women with Endometrial Cancer

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 602
Author(s):  
Jure Knez ◽  
Leyla Al Mahdawi ◽  
Iztok Takač ◽  
Monika Sobočan
Keyword(s):  
Endometrial Cancer ◽  
Fertility Preservation ◽  
Gynecological Cancer ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Developed Countries ◽  
Reproductive Age ◽  
Younger Women ◽  
Future Fertility ◽  
Fertility Sparing

Endometrial cancer is the most common gynecological cancer in developed countries. The disease is diagnosed with increasing frequency in younger women, commonly also in their reproductive age. The standard treatment of endometrial cancer is surgical in the form of hysterectomy and bilateral salpingo-oophorectomy, and this precludes future fertility in younger women. The current challenge is to identify the group of women with endometrial cancer and low-risk features that would benefit from more conservative treatment options. More focus in management needs to be aimed towards the preservation of quality of life, without jeopardizing oncological outcomes. In this review, we analyze the current approaches to identification of women for conservative management and evaluate the success of different medical options for treatment and surgical techniques that are fertility sparing. We also elaborate on the future perspectives, focusing on the incorporation of molecular characterization of endometrial cancer to fertility preservation algorithms. Future studies should focus specifically on identifying reliable clinical and molecular predictive markers in this group of young women. With improved knowledge and better risk assessment, the precision medicine is the path towards improved understanding of the disease and possibly widening the group of women that could benefit from treatment methods preserving their fertility.

scholarly journals Fertility-Sparing Treatment of Patients with Endometrial Cancer: A Review of the Literature

2021 ◽  
Vol 10 (20) ◽  
pp. 4784
Author(s):  
Umberto Leone Roberti Maggiore ◽  
Rola Khamisy-Farah ◽  
Nicola Luigi Bragazzi ◽  
Giorgio Bogani ◽  
Fabio Martinelli ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Female Genital Tract ◽  
Young Patients ◽  
Developed Countries ◽  
Significant Shift ◽  
High Quality Evidence ◽  
Fertility Sparing ◽  
Rich Countries ◽  
Common Malignancy ◽  
Female Genital

Endometrial cancer (EC) is currently the most common malignancy of the female genital tract in developed countries. Although it is more common in postmenopausal women, it may affect up to 25% in the premenopausal age and 3–5% under the age of 40 years. Furthermore, in the last decades a significant shift to pregnancy at older maternal ages, particularly in resource-rich countries, has been observed. Therefore, in this scenario fertility-sparing alternatives should be discussed with patients affected by EC. This study summarizes available literature on fertility-sparing management of patients affected by EC, focusing on the oncologic and reproductive outcomes. A systematic computerized search of the literature was performed in two electronic databases (PubMed and MEDLINE) in order to identify relevant articles to be included for the purpose of this systematic review. On the basis of available evidence, fertility-sparing alternatives are oral progestins alone or in combination with other drugs, levonorgestrel intrauterine system and hysteroscopic resection in association with progestin therapies. These strategies seem feasible and safe for young patients with G1 endometrioid EC limited to the endometrium. However, there is a lack of high-quality evidence on the efficacy and safety of fertility-sparing treatments and future well-designed studies are required.

scholarly journals Fertility Sparing Treatment of Endometrial Cancer with and without Initial Infiltration of Myometrium: A Single Center Experience

Cancers ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3571
Author(s):  
Paolo Casadio ◽  
Mariangela La Rosa ◽  
Andrea Alletto ◽  
Giulia Magnarelli ◽  
Alessandro Arena ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Conservative Treatment ◽  
Young Women ◽  
Operative Hysteroscopy ◽  
Single Center Experience ◽  
Fertility Sparing ◽  
Feasible Alternative ◽  
Endometrioid Endometrial Cancer ◽  
First Time

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.

Fertility sparing surgery for stage IA type I and G2 endometrial cancer in reproductive-aged patients: evidence-based approach and future perspectives

2017 ◽  
Vol 69 (1) ◽  
pp. 29-34 ◽  
Author(s):  
Salvatore Giovanni Vitale ◽  
Diego Rossetti ◽  
Alessandro Tropea ◽  
Antonio Biondi ◽  
Antonio Simone Laganà
Keyword(s):  
Endometrial Cancer ◽  
Evidence Based ◽  
Type I ◽  
Future Perspectives ◽  
Aged Patients ◽  
Fertility Sparing Surgery ◽  
Fertility Sparing ◽  
Stage Ia

Combined Oral Medroxyprogesterone/Levonorgestrel-Intrauterine System Treatment for Women With Grade 2 Stage IA Endometrial Cancer

2017 ◽  
Vol 27 (4) ◽  
pp. 738-742 ◽  
Author(s):  
Ji Young Hwang ◽  
Da Hee Kim ◽  
Hyo Sook Bae ◽  
Mi-La Kim ◽  
Yong Wook Jung ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Progressive Disease ◽  
Medical Center ◽  
Endometrial Adenocarcinoma ◽  
Complete Response ◽  
Dilatation And Curettage ◽  
Fertility Sparing ◽  
Stage Ia ◽  
The Mean

ObjectiveThe aim of this study was to evaluate the oncologic and pregnancy outcomes of combined oral medroxyprogesterone acetate (MPA)/levonorgestrel-intrauterine system (LNG-IUS) treatment in young women with grade 2–differentiated stage IA endometrial adenocarcinoma who wish to preserve fertility.MethodsWe retrospectively reviewed the medical records of patients with grade 2 stage IA endometrial adenocarcinoma who had received fertility-sparing treatment at CHA Gangnam Medical Center between 2011 and 2015. All of the patients were treated with combined oral MPA (500 mg/d)/LNG-IUS, and follow-up dilatation and curettage were performed every 3 months.ResultsA total of 5 patients were included in the study. The mean age was 30.4 ± 5.3 years (range, 25–39 years). After a mean treatment duration of 11.0 ± 6.2 months (range, 6–18 months), complete response (CR) was shown in 3 of the 5 patients, with partial response (PR) in the other 2 patients. One case of recurrence was reported 14 months after achieving CR. This patient was treated again with combined oral MPA/LNG-IUS and achieved CR by 6 months. The average follow-up period was 44.4 ± 26.2 months (range, 12–71 months). There were no cases of progressive disease. No treatment-related complications arose.ConclusionsCombined oral MPA/LNG-IUS treatment is considered to be a reasonably effective fertility-sparing treatment of grade 2 stage IA endometrial cancer. Although our results are encouraging, it is preliminary and should be considered with experienced oncologists in well-defined protocol and with close follow-up.

scholarly journals Palliative treatment of endometrial cancer: what is the role of anastrozole in elderly women?

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Barbara Gardella ◽  
Mattia Dominoni ◽  
Stefano Bogliolo ◽  
Chiara Cassani ◽  
Giulia Vittoria Carletti ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Surgical Treatment ◽  
Palliative Treatment ◽  
Elderly Women ◽  
Population Aging ◽  
Endometrial Thickness ◽  
Developed Countries ◽  
Type I ◽  
Validated Questionnaire ◽  
Radiological Staging

Abstract Background Type I endometrial cancer is the most common gynaecological tumour in developed countries and its incidence is increasing also because of population aging. The aim of this work is to test the feasibility and safety of anastrozole as palliative treatment of endometrial cancer in elderly women ineligible for standard surgical treatment. Methods Patients with histological diagnosis of type I endometrial cancer not suitable for surgical treatment were enrolled in this pilot study. Anastrozole was administered 1 mg daily orally after performing an accurate clinical and radiological staging. Validated questionnaire and self-reported outcomes were used to evaluate quality of life and compliance during the study period. Results Eight patients with a mean age of 85 (range 80–88 years) were enrolled. All patients had endometrial cancer confined to the uterus, and none progression of disease was observed during the study period. A partial response to the therapy was reported in seven patients, while one patient had stable disease. Tumour symptoms improvement such as pain, vaginal bleeding and vaginal discomfort was reported. The endometrial thickness after twelve months has showed a reduction of 9.25 ± 4.77 mm. The average follow-up time was 18.25 months. Four women died for non oncological reasons, none death related to endometrial cancer was reported. Evaluation of symptoms showed a significant reduction of appetite loss and insomnia, while a significant increase of global health status and fatigue was reported. Conclusions Our preliminary data suggested that the palliative use of anastrozole may be a suitable therapy for the proper management of early stages endometrial cancer in elderly women not suitable for surgical treatment with good compliance and tolerance. Trial registration 2013000840. Date of registration: 21/09/2013. URL: trials.sanmatteo.loc.

Sign in / Sign up

Export Citation Format

Share Document