Management options and fertility‐preserving therapy for premenopausal endometrial hyperplasia and early‐stage endometrial cancer

Gressel, Gregory M.; Parkash, Vinita; Pal, Lubna

doi:10.1016/j.ijgo.2015.06.031

Cited by 34 publications

(32 citation statements)

References 42 publications

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“…Conservative treatment strategies maintaining fertility have been described for both atypical hyperplasia and well-differentiated FIGO stage IA endometrial carcinoma without myometrial invasion. 25,26 Expert review was previously suggested for such patients to minimize risk associated with preserving the uterus. 27 Our findings clearly support such a recommendation and concur with published treatment guidelines for endometrial carcinoma.…”

Section: Discussionmentioning

confidence: 99%

Second Opinion Expert Pathology in Endometrial Cancer: Potential Clinical Implications

Grevenkamp¹,

Kommoss²,

Kommoss³

et al. 2017

Int J Gynecol Cancer

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A retrospective gynecopathological case review was shown to reveal limited but significant discrepancies in histological diagnoses as well as typing and grading of endometrial carcinomas, some directly impacting clinical management. Second opinion pathology therefore not only helps to improve the quality of translational research study cohorts but might also help to optimize patient care in difficult cases.

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Section: Discussionmentioning

confidence: 99%

Second Opinion Expert Pathology in Endometrial Cancer: Potential Clinical Implications

Grevenkamp¹,

Kommoss²,

Kommoss³

et al. 2017

Int J Gynecol Cancer

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“…Although initial reports were promising, GnRH only exhibited low response rates in cases with previous exposure to P4 (43). Also, the prolonged use of GnRH and aromatase inhibitors can lead to symptoms of menopause such as bone loss, osteoporosis, and endometrial atrophy (44). Based on its successful use in ovarian cancer, Poly (ADP-ribose) polymerase (PARP) inhibition recently also found its way into the treatment of EC.…”

Section: Discussionmentioning

confidence: 99%

Imiquimod Induces Apoptosis in Human Endometrial Cancer Cells In vitro and Prevents Tumor Progression In vivo

et al. 2016

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Purpose The increasing incidence of endometrial cancer (EC), in younger age at diagnosis, calls for new tissue-sparing treatment options. This work aims to evaluate the potential of imiquimod (IQ) in the treatment of low-grade EC. Methods Effects of IQ on the viabilities of Ishikawa and HEC-1A cells were evaluated using MTT assay. The ability of IQ to induce apoptosis was evaluated by testing changes in caspase 3/7 levels and expression of cleaved caspase-3, using luminescence assay and western blot. Apoptosis was confirmed by flow cytometry and the expression of cleaved PARP. Western blot was used to evaluate the effect of IQ on expression levels of Bcl-2, Bcl-xL, and BAX. Finally, the in vivo efficacy of IQ was tested in an EC mouse model. Results There was a decrease in EC cell viability following IQ treatment as well as increased caspase 3/7 activities, cleaved caspase-3 expression, and Annexin-V/ 7AAD positive cell population. Western blot results showed the ability of IQ in cleaving PARP, decreasing Bcl-2 and Bcl-xL expressions, but not affecting BAX expression. In vivo study demonstrated IQ’s ability to inhibit EC tumor growth and progression without significant toxicity. Conclusions IQ induces apoptosis in low-grade EC cells in vitro, probably through its direct effect on Bcl-2 family protein expression. In, vivo, IQ attenuates EC tumor growth and progression, without an obvious toxicity. Our study provides the first building block for the potential role of IQ in the non-surgical management of low-grades EC and encouraging further investigations.

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“…(Zivanovic et al ,2009; Bogani et al ., 2015). Currently, fertility preservation options in endometrial cancer are limited to hormonal methods (Signorelli et al ., 2009; Gressel et al ., 2015). Patients desiring to proceed with conservative hormonal management should be extensively counseled regarding potential risks as no scientifically proven optimal progestin regimen exists (Eskander et al ., 2011; Loren et al ., 2013; von Wolff et al , 2015).…”

Section: Introductionmentioning

confidence: 99%

“…It is important to emphasize that such an approach is not standard and should be considered only if the patient insists (Bogani et al ., 2016; Gressel et al ., 2015). Careful and thorough counseling is mandatory in this setting (Loren et al ., 2013; Lambertini et al.…”

Section: Introductionmentioning

confidence: 99%

“…Prognosis is established based on histological grade, depth of myometrial invasion, cervical involvement, vascular space involvement, pelvic and aortic lymph node metastases, adnexal metastases, and positive peritoneal cytology (Guan et al ., 2011). Apparently, the stage of the tumor is the most important factor in predicting patients' outcome as it determines the mode of treatment and significantly influences survival (Gressel et al ., 2015; Bogani et al ., 2016). No optimal method of evaluation prior to conservative management has been identified so far, hence multiple noninvasive or minimally invasive diagnostic methods are employed to attempt to 'clinically stage' a patient (Zivanovic et al , 2009; Bogani et al ., 2016).…”

Section: Introductionmentioning

confidence: 99%

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Fertility-preservation in endometrial cancer: is it safe? Review of the literature

Carneiro

Lamaita

Ferreira

et al. 2016

JBRA Assisted Reproduction

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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.

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Management options and fertility‐preserving therapy for premenopausal endometrial hyperplasia and early‐stage endometrial cancer

Abstract: Conservative management could be appropriate for carefully selected women with complex atypical endometrial hyperplasia or early-stage endometrial cancer who desire future fertility.

Cited by 34 publications

References 42 publications

Second Opinion Expert Pathology in Endometrial Cancer: Potential Clinical Implications

Second Opinion Expert Pathology in Endometrial Cancer: Potential Clinical Implications

Imiquimod Induces Apoptosis in Human Endometrial Cancer Cells In vitro and Prevents Tumor Progression In vivo

Fertility-preservation in endometrial cancer: is it safe? Review of the literature

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