Circulating miRNAs as a Tool for Early Diagnosis of Endometrial Cancer—Implications for the Fertility-Sparing Process: Clinical, Biological, and Legal Aspects

Abstract

This review article explores the possibility of developing an integrated approach to the management of the different needs of endometrial cancer (EC) patients seeking to become pregnant. Life preservation of the woman, health preservation of the baby, a precocious and—as much as possible—minimally invasive characterization of the health and fertility parameters of the patient, together with the concerns regarding the obstetric, neonatal, and adult health risks of the children conceived via assisted reproductive techniques (ART) are all essential aspects of the problem to be taken into consideration, yet the possibility to harmonize such needs through a concerted and integrated approach is still very challenging. This review aims to illustrate the main features of EC and how it affects the normal physiology of pre-menopausal women. We also focus on the prospect of a miR-based, molecular evaluation of patient health status, including both EC early diagnosis and staging and, similarly, the receptivity of the woman, discussing the possible evaluation of both aspects using a single specific panel of circulating miRs in the patient, thus allowing a relatively fast, non-invasive testing with a significantly reduced margin of error. Finally, the ethical and legal/regulatory aspects of such innovative techniques require not only a risk-benefit analysis; respect for patient autonomy and equitable health care access allocation are fundamental issues as well.

Validating the 2023 FIGO staging system: A nomogram for endometrioid endometrial cancer and adenocarcinoma

“…Accumulating evidence suggests that employing conservative approaches and close monitoring until delivery does not compromise the survival outcomes of endometrial cancer patients. For patients without male partners or those unwilling to cryopreserve embryos, oocyte preservation can be achieved through vitrification and slow cooling techniques 31,32 . Notably, vitrification techniques mitigate the risk of multiple pregnancies and ovarian hyperstimulation syndrome 31,32 .…”

“…For patients without male partners or those unwilling to cryopreserve embryos, oocyte preservation can be achieved through vitrification and slow cooling techniques. 31 , 32 Notably, vitrification techniques mitigate the risk of multiple pregnancies and ovarian hyperstimulation syndrome. 31 , 32 For babies conceived by assisted reproductive technologies, including oocyte cryopreservation, the long‐term health implications warrant further investigation.…”

“… 31 , 32 Notably, vitrification techniques mitigate the risk of multiple pregnancies and ovarian hyperstimulation syndrome. 31 , 32 For babies conceived by assisted reproductive technologies, including oocyte cryopreservation, the long‐term health implications warrant further investigation.…”

Stem Cells and Infertility: A Review of Clinical Applications and Legal Frameworks

“…Fertility preservation (FP) emerged as a treatment aiming to preserve future reproductive capacity of individuals facing therapies that could potentially affect their gonads [102] or if needed to perform a fertility sparing surgery treatments in case of diagnosis of malignancies and especially in reproductive age [103][104][105][106][107]. The majority being patients diagnosed with cancer, cryopreservation of oocytes or embryos by vitrification [108] is the most common way to preserve fertility and for future needed especially at the parentinghood time.…”

Preoperative Haematologic Markers for the Differentiation of Endometrial Cancer from Benign Endometrial Lesions in Postmenopausal Patients with Endometrial Masses

“…It has been reported that hundreds of ncRNAs are potentially deregulated in EC and ncRNAs can be detected in the blood circulation; therefore, circulating ncRNAs can be fast, accurate, and minimally invasive diagnostic tools. 44 , 47 Circulating micro RNAs of EC patients as diagnostic, prognostic and therapeutic markers could be potentially applicable for personalized medicine in the future. 44 …”