Conservative Management of Atypical Endometrial Hyperplasia and Early Endometrial Cancer in Childbearing Age Women
Total hysterectomy and bilateral adnexectomy is the standard treatment for atypical endometrial hyperplasia and early-stage endometrial cancer. However, the recommended surgical treatment precludes future pregnancy when these conditions are diagnosed in women in their fertile age. In these patients,...
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MDPI AG
2022-09-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/58/9/1256 |
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| author | Stefano Uccella Pier Carlo Zorzato Susan Dababou Mariachiara Bosco Marco Torella Andrea Braga Matteo Frigerio Barbara Gardella Stefano Cianci Antonio Simone Laganà Massimo Piergiuseppe Franchi Simone Garzon |
| author_facet | Stefano Uccella Pier Carlo Zorzato Susan Dababou Mariachiara Bosco Marco Torella Andrea Braga Matteo Frigerio Barbara Gardella Stefano Cianci Antonio Simone Laganà Massimo Piergiuseppe Franchi Simone Garzon |
| author_sort | Stefano Uccella |
| collection | DOAJ |
| description | Total hysterectomy and bilateral adnexectomy is the standard treatment for atypical endometrial hyperplasia and early-stage endometrial cancer. However, the recommended surgical treatment precludes future pregnancy when these conditions are diagnosed in women in their fertile age. In these patients, fertility-sparing treatment may be feasible if the desire for childbearing is consistent and specific conditions are present. This review summarizes the available evidence on fertility-sparing management for atypical endometrial hyperplasia and early-stage endometrial cancer. Historically, oral progestins have been the mainstay of conservative management for atypical endometrial hyperplasia and stage IA endometrioid endometrial cancer with no myometrial invasion, although there is no consensus on dosage and treatment length. Intrauterine progestin therapy has proved a valid alternative option when oral progestins are not tolerated. GnRH analogs, metformin, and hysteroscopic resection in combination with progestins appear to increase the overall efficacy of the treatment. After a complete response, conception is recommended; alternatively, maintenance therapy with strict follow-up has been proposed to decrease recurrence. The risk of disease progression is not negligible, and clinicians should not overlook the risk of hereditary forms of the disease in young patients, in particular, Lynch syndrome. Hysterectomy is performed once the desire for childbearing desire has been established. The conservative management of atypical endometrial hyperplasia and early-stage endometrial cancer is feasible, provided a strong desire for childbearing and permitting clinical–pathological conditions. However, patients must be aware of the need for a strict follow-up and the risk of progression with a possible consequent worsening of the prognosis. More homogenous and well-designed studies are necessary to standardize and identify the best treatment and follow-up protocols. |
| first_indexed | 2024-03-09T23:13:27Z |
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| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-09T23:13:27Z |
| publishDate | 2022-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-2b1f1037af1047e29932211f0bb22f122023-11-23T17:40:33ZengMDPI AGMedicina1010-660X1648-91442022-09-01589125610.3390/medicina58091256Conservative Management of Atypical Endometrial Hyperplasia and Early Endometrial Cancer in Childbearing Age WomenStefano Uccella0Pier Carlo Zorzato1Susan Dababou2Mariachiara Bosco3Marco Torella4Andrea Braga5Matteo Frigerio6Barbara Gardella7Stefano Cianci8Antonio Simone Laganà9Massimo Piergiuseppe Franchi10Simone Garzon11Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, 37126 Verona, ItalyDepartment of Obstetrics and Gynecology, AOUI Verona, University of Verona, 37126 Verona, ItalyDepartment of Obstetrics and Gynecology, AOUI Verona, University of Verona, 37126 Verona, ItalyDepartment of Obstetrics and Gynecology, AOUI Verona, University of Verona, 37126 Verona, ItalyObstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, ItalyDepartment of Obstetrics and Gynecology, EOC—Beata Vergine Hospital, 6850 Mendrisio, SwitzerlandGynecology Department, San Gerardo Hospital, Milano Bicocca University, ASST Monza, 20900 Monza, ItalyDepartment of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, ItalyUnit of Gynecology and Obstetrics, Department of Human Pathology of Adult and Childhood “G. Barresi”, University of Messina, 98121 Messina, ItalyUnit of Gynecologic Oncology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), ARNAS “Civico-Di Cristina-Benfratelli” Hospital, University of Palermo, 90127 Palermo, ItalyDepartment of Obstetrics and Gynecology, AOUI Verona, University of Verona, 37126 Verona, ItalyDepartment of Obstetrics and Gynecology, AOUI Verona, University of Verona, 37126 Verona, ItalyTotal hysterectomy and bilateral adnexectomy is the standard treatment for atypical endometrial hyperplasia and early-stage endometrial cancer. However, the recommended surgical treatment precludes future pregnancy when these conditions are diagnosed in women in their fertile age. In these patients, fertility-sparing treatment may be feasible if the desire for childbearing is consistent and specific conditions are present. This review summarizes the available evidence on fertility-sparing management for atypical endometrial hyperplasia and early-stage endometrial cancer. Historically, oral progestins have been the mainstay of conservative management for atypical endometrial hyperplasia and stage IA endometrioid endometrial cancer with no myometrial invasion, although there is no consensus on dosage and treatment length. Intrauterine progestin therapy has proved a valid alternative option when oral progestins are not tolerated. GnRH analogs, metformin, and hysteroscopic resection in combination with progestins appear to increase the overall efficacy of the treatment. After a complete response, conception is recommended; alternatively, maintenance therapy with strict follow-up has been proposed to decrease recurrence. The risk of disease progression is not negligible, and clinicians should not overlook the risk of hereditary forms of the disease in young patients, in particular, Lynch syndrome. Hysterectomy is performed once the desire for childbearing desire has been established. The conservative management of atypical endometrial hyperplasia and early-stage endometrial cancer is feasible, provided a strong desire for childbearing and permitting clinical–pathological conditions. However, patients must be aware of the need for a strict follow-up and the risk of progression with a possible consequent worsening of the prognosis. More homogenous and well-designed studies are necessary to standardize and identify the best treatment and follow-up protocols.https://www.mdpi.com/1648-9144/58/9/1256endometrial cancerendometrial atypical hyperplasiafertility-sparing treatmentconservative treatment |
| spellingShingle | Stefano Uccella Pier Carlo Zorzato Susan Dababou Mariachiara Bosco Marco Torella Andrea Braga Matteo Frigerio Barbara Gardella Stefano Cianci Antonio Simone Laganà Massimo Piergiuseppe Franchi Simone Garzon Conservative Management of Atypical Endometrial Hyperplasia and Early Endometrial Cancer in Childbearing Age Women Medicina endometrial cancer endometrial atypical hyperplasia fertility-sparing treatment conservative treatment |
| title | Conservative Management of Atypical Endometrial Hyperplasia and Early Endometrial Cancer in Childbearing Age Women |
| title_full | Conservative Management of Atypical Endometrial Hyperplasia and Early Endometrial Cancer in Childbearing Age Women |
| title_fullStr | Conservative Management of Atypical Endometrial Hyperplasia and Early Endometrial Cancer in Childbearing Age Women |
| title_full_unstemmed | Conservative Management of Atypical Endometrial Hyperplasia and Early Endometrial Cancer in Childbearing Age Women |
| title_short | Conservative Management of Atypical Endometrial Hyperplasia and Early Endometrial Cancer in Childbearing Age Women |
| title_sort | conservative management of atypical endometrial hyperplasia and early endometrial cancer in childbearing age women |
| topic | endometrial cancer endometrial atypical hyperplasia fertility-sparing treatment conservative treatment |
| url | https://www.mdpi.com/1648-9144/58/9/1256 |
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