Fertility-Sparing Treatment Options in Young Patients with Early-Stage Endometrial Cancer

Abstract

Purpose of Review To summarize fertility-sparing treatment options in young patients with early-stage endometrial cancer. Recent Findings A levonorgestrel-releasing intrauterine device combined with oral progestins seems more effective for patients with endometrial cancer and desiring fertility. Assisted reproductive techniques seem more effective in achieving pregnancy in these young cancer patients than natural conception. Endometrial cancer is the most common gynecologic cancer in developed countries. For younger patients who wish to have children, fertility preservation methods are available, but not always reasonable in an individual patient. Furthermore, fertility-preserving treatment has some risks with regard to surgical effectivity. The main criteria for fertility-sparing treatment are reproductive age of the patient, fertility desire, a grade 1 well-differentiated tumor, diagnosis should be performed through D&C, stage 1A tumor with no evidence of myometrial invasion on MRI, and no suspicious adnexal mass. A levonorgestrel-releasing intrauterine device combined with oral progestins seems more effective than using oral progestins alone. D&C should be performed every 3 months after the start of progestin therapy. Patients with two negative endometrial D&C results are considered to have a complete response and eligible for pregnancy. Hysteroscopic resection can be used in patients with grade 1 stage 1 endometrial carcinoma who did not respond to progestin treatment.