Almost 5% of women with endometrial cancer are under age 40, and they often have
well-differentiated endometrioid estrogen-dependent tumors. Cancer survival
rates have improved over the last decades so strategies to avoid or reduce the
reproductive damage caused by oncologic treatment are needed. We reviewed the
published literature to find evidence to answer the following questions: How
should we manage women in reproductive age with endometrial cancer? How safe is
fertility preservation in endometrial cancer? Can pregnancy influence
endometrial cancer recurrence? What are the fertility sparing options available?
Progestins may be prescribed after careful evaluation and counseling. Suitable
patients should be selected using imaging methods and endometrial sampling since
surgical staging will not be performed. Conservative treatment should only be
offered to patients with grade 1 well-differentiated tumors, absence of lymph
vascular space invasion, no evidence of myometrial invasion, metastatic disease
or suspicious adnexal masses, and expression of progesterone receptors in the
endometrium. The presence of co-existing ovarian metastatic of synchronous
cancer should be investigated and ruled out before the decision to preserve the
ovaries. The availability of Assisted Reproductive Technology (ART) has made it
possible for women with endometrial cancer to give birth to a child without
compromising their prognoses. Gamete, embryo or ovarian tissue cryopreservation
techniques can be employed, although the latter remains experimental.
Unfortunately, fertility preservation is rarely considered. Current
recommendations for conservative management are based on the overall favorable
prognosis of grade 1 minimally invasive tumors. Selected patients with
endometrial cancer may be candidates to a safe fertility-preserving
management.
Innate and adaptive immune cells secrete different cytokines, which participate through distinct mechanisms in cell-mediated immunity and humoral immune responses. The aim of this study was to evaluate the immune response through analysis of type 1 (Th1), Th2, and Th17 cells in patients with epithelial ovarian cancer (EOC). Our study included 44 patients with EOC (study group) and 32 gynecological patients with no ovarian disease (control group). Fragments of ovarian tissue and blood samples were collected in both groups and aliquots of intracystic fluid and peritoneal fluid were recovered from the EOC patient group. Interleukin (IL)-2/IL-4/IL-6/IL-10/IL-17/tumor necrosis factor (TNF)-α/interferon (IFN)-γ levels were measured by cytometric bead array. Statistical analysis included chi-squared, Student t, Mann-Whitney, Kruskal-Wallis tests, and Cox regression model. Patients with EOC were associated with higher levels of TNF-α/IL-4/IL-6/IL-10 compared to the control group. Both IL-10 and TNF-α concentrations were higher in patients with stage III/IV EOC and also associated with higher levels of cancer antigen 125. Higher Th1-mediated immune response was observed when the cytoreduction was considered optimal. However, patients with EOC with unsatisfactory cytoreductive surgery and undifferentiated tumors were associated with higher concentrations of Th2 cytokines in the 4 sites studied. Higher IL-6/IL-10 and lower IFN-γ concentrations were also associated with a lower overall survival rate in patients with EOC. The EOC group presented a predominantly Th2 response and an immunosuppressant standard and had association between IL-6/IL-10/IFN-γ and prognosis.
Respondents to a web-based survey in four Latin American countries have misperceptions regarding the adverse effects and risks of intrauterine contraception, which may hamper the use of these safe and efficient contraceptive methods. Education about the true risks and benefits involved is fundamental to improving patient acceptance and compliance as well as reducing unplanned pregnancies and unsafe abortions.
Infertile patients with endometriosis show a distinct pattern of serum and follicular fluid macrophage/neutrophil activation compared to normally ovulating women undergoing ICSI, which may reflect the role of immune and inflammatory alterations in endometriosis-related infertility.
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