Conservative treatment of endometrial adenocarcinoma in young women with hormone therapy

Hur, Soo Young

Abstract

Endometrial cancer is the ninth common cancer in women and the third common gynecologic cancer in Korea. Although it is primarily a disease of the postmenopausal female, 3-5% of patients are 40 years old or younger. Because of the particularly good prognosis for young women with early stage endometrial cancer, the limited myometrial invasion and high tumor differentiation, and because most of the women also suffer from subfertility, many attempts have been made to treat such cases conservatively with hormonal therapy rather than with surgery. This article discusses the current, available data about conservative management of endometrial cancer in young women. A comprehensive pretreatment evaluation including dilatation and curettage, pelvic ultrasound, abdominopelvic computed tomography, and pelvic magnetic resonance imaging is critical. Detailed counseling is essential. Multiple effective protocols exist for conservative treatment of endometrial cancer, and the initial response rates are as high as 57 to 75%. When the patient finishes her fertility plans, the option of hysterectomy should be considered. Most of studies have been based on retrospective case reports, and many questions still remain unanswered regarding the optimal treatment protocol or long-term surveillance for conservative management of these patients. Larger prospective clinical studies are warranted.