Fertility-sparing treatment of endometrial cancer
Affiliation and adress for correspondence
Department of Gynecology, Obstetrics and Gynecologic Oncology, Medical University of Silesia in Katowice, Bytom, Poland. Head of the Department: Professor Anita Olejek, MD, PhD
Correspondence: Kamila Trepka, Specialist Hospital No. 2, Batorego 15, 41-902 Bytom, Poland, tel.: +48 661 281 950, fax: +48 32 786 14 00, e-mail: kamilatrepka@gmail.com
Curr Gynecol Oncol 2019, 17 (1), p. 43–48
DOI: 10.15557/CGO.2019.0005
ABSTRACT

Endometrial carcinoma is the most common gynecologic cancer. Surgical treatment primarily involves hysterectomy with bilateral salpingo-oophorectomy and, in selected cases, pelvic and periaortic lymphadenectomy. In premenopausal patients (in Poland 5% of cases are women below 40 years of age) it is possible to consider fertility-sparing treatment. The aim of this article is to summarize the methods and outcomes of fertility-sparing treatment and ways of assessing patients for such management taking into account the stage and grade of the disease. A patient is assessed for conservative treatment based on preliminary grading and staging of cancer. Cancer grade should be determined based on cervical and uterine dilation and curettage sample examination, which is more accurate than endometrial biopsy. However, if no surgery has been performed, staging can only be predictive, with magnetic resonance imaging providing the most accurate information. In clinical practice there is no cheap and repeatable non-surgical prognostic model for endometrial cancer staging. In patients treated conservatively, provided that contraindications have been excluded, oral gestagens or levonorgestrel-releasing intrauterine systems may be used or a hysteroscopic excision of the focal abnormal tissue may be performed. Patients require regular follow-up due to the risk of lack of response to treatment or recurrence. In young patients who have had their planned number of children it is also possible to consider hysterectomy with salpingectomy with the ovaries left in place. There is a possibility of conservative endometrial cancer treatment, but only in carefully selected cases. Staging and grading of cancer and treatment response monitoring remain the most significant challenges.

Keywords: endometrial cancer, conservative treatment, staging, grading, fertility