Contemporary Fertility-Sparing Management Options of Early Stage Endometrioid Endometrial Cancer in Young Nulliparous Patients

Abstract

Incidence of endometrial cancer (EC) has been increasing in recent years, especially in high-income countries. The disease commonly affects peri- and postmenopausal women; however, about 5% of women are diagnosed with EC in their reproductive age. Due to both the increasing incidence of EC among reproductive age women and trends to delayed childbearing, fertility-sparing treatment for young patients with EC has become extremely important for researchers and practitioners. Because the classic treatment with total hysterectomy and bilateral saplingo-oophorectomy is not an appropriate approach for young women demanding fertility preservation, several fertility-sparing options have been developed and summarized in this review. Utilization of different medications and their combination (progestagens, gonadotropin releasing hormones analogues, and metformin in different formulations) are tested and found as efficient for fertility-sparing treatment. New minimally invasive surgical techniques, combined with progestagens, are also confirmed as valuable. There are many novel conservative and surgical treatment approaches under investigation. Assuming that molecular biomarkers can be both diagnostic and prognostic to assist in prediction of response to a certain therapy, prognostic risk groups’ stratification along with specific biomarkers’ identification will ensure low recurrence and decrease mortality rates in young women with EC.

Factors Influencing on Pain in Patients Undergoing Pipelle Endometrial Biopsy for Abnormal Uterine Bleeding: Why a Personalized Approach Should Be Applied?

“…Abnormal uterine bleeding is very important in daily practice, and histologic assessment of endometrial tissue obtained with biopsy with exclusion of endometrial pathology as an underlying cause of it is essential [ 2 , 3 , 9 , 13 , 23 ]. The majority of endometrial sampling procedures are performed in outpatient settings, and the most important obstacle for the successful completion of procedures is pain [ 24 ].…”

“…Abnormal uterine bleeding (AUB) is a complaint of one-third of outpatient visits to gynecologist, more than two-thirds of consultations for peri- and postmenopausal patients, and 5% of emergency department visits [ 1 , 2 , 3 , 4 ]. Depending on the age, patients might have various underlying pathologies [ 5 , 6 , 7 , 8 , 9 ] and endometrial biopsy, such as conventional dilatation and curettage (D&C), hysteroscopy, and aspirations procedures, are used to establish the right diagnosis [ 1 , 3 , 10 , 11 , 12 , 13 ].…”

Progestin-primed ovarian stimulation for fertility preservation in women with cancer: A comparative study

“…Noteworthy, even women with early endometrial cancer are now considered for conservative management. They are treated hormonally to achieve transient cancer regression, thus allowing pregnancy seeking and postponing hysterectomy after delivery [7][8][9][10].…”

Fertility-Sparing Strategies for Early-Stage Endometrial Cancer: Stepping towards Precision Medicine Based on the Molecular Fingerprint

“…Endometrial cancer represents the fifth most common cancer in women, and the most common gynecological malignancy in developed countries [1]. Although endometrial cancer usually develops during the post-menopausal period, according to recent data, 15-25% of cases occur before menopause [2], when there may still be a desire of pregnancy. In premenopausal women, the most common clinical signs in the case of suspected endometrial cancer are abnormal uterine bleeding, intermenstrual bleeding, and to a lesser extent, pelvic pain [3].…”