Abstract
Objective
To know the characteristics of endometrial adenocarcinoma in young patients and to review the published experience in patients with endometrial adenocarcinoma that were conservatively managed with hormonal therapy to spare their fertility.
Methods
We carried out a search in the Survey conducted by the Section of Oncologic Gynecology of SEGO (Spanish Society of Gynecologists) to identify the characteristics of young patients with endometrial adenocarcinoma. In addition we searched MEDLINE and other databases for English-language articles describing patients with endometrial adenocarcinoma who were treated with hormonal therapy. The search included articles published between January 1966 and January 2007.
Results
Endometrial carcinoma in patients under 45 years old is an unusual condition that shows a more favourable pattern than in older patients. One hundred and thirty-three patients were found in the search. The average duration of hormonal therapy was approximately six months. The average response time was 12 weeks; 76% of patients treated with hormonal therapy had a complete response and the other 24% never responded to treatment. Of those who initially responded, 66% percent did not show recurrence of disease. The other 34% had a relapse. There have been 4 published deaths of conservatively managed patients.
Conclusion
A conservative approach in these patients can offer reasonable oncological security and the opportunity of fulfilling their maternal desires in selected cases. However, consideration should be taken regarding the potential adverse outcomes that have been recently published in the literature.
Similar content being viewed by others
References
(2004) Cancer facts & figures, 2004. American Cancer Society, Atlanta, GA
Ibáñez E, Chiva L, Rodríguez-Escudero FJ (1999) Resultados de la Encuesta Nacional sobre Carcinoma de Endometrio Diagnosticado en 1993. En Avances en Ginecología Oncológica. Rodríguez-Escudero Eds, Caceres
Herruzo A, Carmona M, Chiva L et al (2003) Evolución de los resultados del tratamiento del cáncer de endometrio en España entre 1980 y 1990. Análisis de las casuísticas nacionales de la sociedad española la de ginecología y obstetricia. Prog Obstet Ginecol 45:54–62
Creasman WT (2002) Adenocarcinoma of the uterus. In: DiSaia PJ, Creasman WT (eds) Clinical gynecologic oncology. St. Louis, MO, Mosby Inc, pp 289–350
Crissman JD, Azoury RS, Barnes AE, Schellhas HF (1981) Endometrial carcinoma in women 40 years of age or younger. Obstet Gynecol 57:699–704
Evans-Metcalf ER, Brooks SE, Reale FR, Baker SP (1998) Profile of women 45 years of age and younger with endometrial cancer. Obstet Gynecol 91:349–354
Bokhman JV, Chepick OF, Volkova AT, Vishnevsky AS (1985) Can primary endometrial carcinoma stage I be cured without surgery and radiation therapy? Gynecol Oncol 20:139–155
Gallup DG, Stock RJ (1984) Adenocarcinoma of the endometrium in women 40 years of age and younger. Obstet Gynecol 64:417
Patsner B (2000) Endometrial cancer in women 45 years of age or younger. Eur J Gynaecol Oncol 21:249–250
Tran BN, Connell PP, Waggoner S et al (2000) Characteristics and outcome of endometrial carcinoma patients age 45 years and younger. Am J Clin Oncol 23:476–480
Fahri DC, Nosanchuk J, Silverberg SG (1986) Endometrial adenocarcinoma in women under 25 years of age. Obstet Gynecol 68:741–745
Gitsch G, Hanzal E, Jensen D, Hacker NF (1995) Endometrial cancer in premenopausal women 45 years and younger. Obstet Gynecol 85:504–508
Lee NK, Cheung MK, Shin JY et al (2007) Prognostic factors for uterine cancer in reproductive-aged women. Obstet Gynecol 109:655–662
Walsh C, Holschneider C, Hoang Y et al (2005) Coexisting ovarian malignancy in young women with endometrial cancer. Obstet Gynecol 106:693–699
Kendall BS, Ronnett BM, Isacson C et al (1998) Reproducibility of the diagnosis of endometrial hyperplasia, AH, and well-differentiated carcinoma. Am J Surg Pathol 22:1012–1019
Ehrlich CE, Young PC, Stehman FB et al (1988) Steroid receptors and clinical outcome in patients with adenocarcinoma of the endometrium. Am J Obstet Gynecol 158:796–807
Pace S, Grassi A, Ferrero S et al (1995) Diagnostic methods of early detection of endometrial hyperplasia and cancer. Eur J Gynaecol Oncol 16:373–381
Bergeron C, Nogales FF, Masseroli M et al (1999) A multicentric European study testing the reproducibility of the WHO classification of endometrial hyperplasia with a proposal of a simplified working classification for biopsy and curettage specimens. Am J Surg Pathol 23:1102–1108
Mutter GL and the Endometrial Collaborative Group (2000) Endometrial Intraepithelial Neoplasia (EIN): will it bring order to chaos? Gynecol Oncol 76:287–290
Kurman RJ, Kaminski PF, Norris HJ (1985) The behavior of endometrial hyperplasia. A long-term study of “untreated” hyperplasia in 170 patients. Cancer 56:403–412
Baak JPA, Wisse-Brekelmans ECM, Fleege JC et al (1992) Assessment of the risk of endometrial cancer in hyperplasia by means of morphological and morphometrical features. Path Res Pract 188:856–859
Larson DM, Johnson KK, Broste SK et al (1995) Comparison of D&C and office endometrial biopsy in predicting final histopathologic grade in endometrial cancer. Obstet Gynecol 86:38–42
Kinkel K, Kaji Y, Yu KK et al (1999) Radiologic staging in patients with endometrial cancer: a metaanalysis. Radiology 212:711–718
Frei KA, Kinkel K (2001) Staging endometrial cancer: role of magnetic resonance imaging. J Magn Reson Imaging 13:850–855
Taieb S, Ceugnart L, Leblanc E et al (2002) MR imaging of endometrial carcinoma: role and limits. Bull Cancer 89:963–968
Yoshida Y, Kurokawa T, Yagihara R, Kotsuji F (2006) The usefulness of FES-PET for the prediction of the therapeutic effect of hormonal therapy in a patient with endometrial cancer — a case report (abstract). J Obstet Gynaecol Res 58:406
Yahata T, Fujita K, Aoki Y, Tanaka K (2006) Long-term conservative therapy for endometrial adenocarcinoma in young women. Hum Reprod 21:1070–1075
Ushijima K, Yahata H, Yoshikawa H et al (2007) Multicenter phase II study of fertility-sparing treatment with medroxyprogesterone acetate for endometrial carcinoma and atypical hyperplasia in young women. J Clin Oncol 25:2798–2803
Varga A, Henriksen E (1961) Clinical and histopathologic evaluation of the effect of 17-alpha-hydroxyprogesterone-17-n-caproate on endometrial carcinoma. Obstet Gynecol 18:658–672
Montz FJ, Bristow RE, Bovicelli A et al (2002) Intrauterine progesterone treatment of early endometrial cancer. Am J Obstet Gynecol 186:651–657
Šparac V, Ujevi? B, Ujevi? M et al (2006) Successful pregnancy after hysteroscopic removal of grade I endometrial carcinoma in a young woman with Lynch syndrome. Int J Gynecol Cancer 16[Suppl 1]:442–445
Vilos GD, Ettler HC, Edris F et al (2007) Endometrioid adenocarcinoma treated by hysteroscopic endomyometrial resection. J Min Inv Gyn 14:119–122
Emons G, Heyl W (2000) Hormonal treatment of endometrial cancer. J Cancer Res Clin Oncol 126:619–623
Gallagher CJ, Oliver RT, Ohram DH (1991) A new treatment for endometrial cancer with gonadotropin-releasing hormone analogue. Br J Obstet Gynaecol 98:1037–1041
De Vriese G, Bonte J (1993) Possible role of goserelin, an LH-RH agonist in the treatment of gynaecological cancers. Eur J Gynaecol Oncol 14:187–191
Agorastos T, Bontis J, Vakiani A et al (1997) Treatment of endometrial hyperplasias with gonadotrophin-releasing hormone agonists: pathological, clinical, morphometric, and DNA-cytometric data. Gynecol Oncol 65:102–114
Kullander S (1992) Treatment of endometrial cancer with GnRH analogues. Recent Result Cancer Res 124:69–73
Saegusa M, Okayasu I (1998) Progesterone therapy for endometrial carcinoma reduces cell proliferation but does not alter apoptosis. Cancer 83:111–121
Emons G, Schröder B, Ortmann O et al (1993) High affinity binding and direct antiproliferative effects of luteinizing hormone-releasing hormone analogs in human endometrial cancer cell lines. J Clin Endocrinol Metab 77:1458–1464
Deligdisch L (1993) Effects of hormone therapy on the endometrium. Mod Pathol 6:94–106
Podratz KC, O’Brien PC, Malkasian GD Jr et al (1985) Effects of progestational agents in treatment of endometrial carcinoma. Obstet Gynecol 66:106–110
Ramirez PT, Frumovitz M, Bodurka DC et al (2004) Hormonal therapy for the management of grade 1 endometrial adenocarcinoma: a literature review. Gynecol Oncol 95:133–138
Yazbeck C, Dhainaut C, Thoury A et al (2005) Outcome of fertility-preserving treatment in young women with endometrial carcinomas. BJOG 112:317–320
Nakao Y, Nomiyama M, Kojima K et al (2004) Successful pregnancies in 2 infertile patients with endometrial adenocarcinoma. Gynecol Obstet Invest 58:68–71
Yarali H, Bozdag G, Aksu T, Ayhan A (2004) A successful pregnancy after intracytoplasmic sperm injection and embryo transfer in a patient with endometrial cancer who was treated conservatively. Fertil Steril 81:214–216
Paulson RJ, Sauer MV, Lobo RA (1990) Pregnancy after in vitro fertilization in a patient with stage I endometrial carcinoma treated with progestins. Fertil Steril 54:735–736
Niwa K, Yokoyama Y, Tanaka T et al (1994) Successful pregnancy in a patient with endometrial carcinoma treated with medroxyprogesterone acetate. Arch Gynecol Obstet 255:91–94
Kimmig R, Strowitzki T, Muller-Hocker J et al (1995) Conservative treatment of endometrial cancer permitting subsequent triplet pregnancy. Gynecol Oncol 58:255–257
Kim YB, Holschneider CH, Ghosh K et al (1997) Progestin alone as primary treatment of endometrial carcinoma in premenopausal women. Report of seven cases and review of the literature. Cancer 79:320–327
Randall TC, Kurman RJ (1997) Progestin treatment of atypical hyperplasia and well-differentiated carcinoma of the endometrium in women under age 40. Obstet Gynecol 90:434–440
Niwa K, Morishita S, Hashimoto M et al (1997) Conservative therapy for endometrial carcinoma in young women treated with repeated curettage and progestogen. Int J Clin Oncol 2:165–169
Zanetta G, Gabriele A, Losa G et al (1997) Conservative management of endometrial carcinoma with prolonged preservation of the uterus in a young patient. Int J Gynecol Cancer 7:332–334
Vinker S, Shani A, Open M et al (1999) Conservative treatment of adenocarcinoma of the endometrium in young patients. Is it appropriate? Eur J Obstet Gynecol Reprod Biol 83:63–65
Sardi J, Anchezar Henry JP, Paniceres G et al (1998) Primary hormonal treatment for early endometrial carcinoma. Eur J Gynaecol Oncol 19: 565–568
Schammel DP, Mittal KR, Kaplan K et al (1998) Endometrial adenocarcinoma associated with intrauterine pregnancy. A report of five cases and a review of the literature. Int J Gynecol Pathol 17:327–335
Kowalczyk CL, Malone J Jr, Peterson EP et al (1999) Well-differentiated endometrial adenocarcinoma in an infertility patient with later conception. A case report. J Reprod Med 44:57–60
Jobo T, Imai M, Kawaguchi M et al (2000) Successful conservative treatment of endometrial carcinoma permitting subsequent pregnancy: report of two cases. Eur J Gynecol Oncol 21:119–122
Mitsushita J, Toki T, Kato K et al (2000) Endometrial carcinoma remaining after term pregnancy following conservative treatment with medroxy progesterone acetate. Gynecol Oncol 79:129–132
Imai M, Jobo T, Sato R et al (2001) Medroxyprogesterone acetate therapy for patients with adenocarcinoma of the endometrium who wish to preserve the uterus — usefulness and limitations. Eur J Gynaecol Oncol 22:217–220
Kaku T, Yoshikawa H, Tsuda H et al (2001) Conservative therapy for adenocarcinoma and atypical endometrial hyperplasia of the endometrium in young women: central pathologic review and treatment outcome. Cancer Lett 167:39–48
Wang CB, Wang CJ, Huang HJ et al (2002) Fertility-preserving treatment in young patients with endometrial adenocarcinoma. Cancer 94:2192–2198
Shibahara H, Shigeta M, Toji H et al (1999) Successful pregnancy in an infertile patient with conservatively treated endometrial adenocarcinoma after transfer of embryos obtained by intracytoplasmic sperm injection. Hum Reprod 14:1908–1911
O’Neill RT (1970) Pregnancy following hormonal therapy for adenocarcinoma of the endometrium. Am J Obstet Gynecol 108:318–321
Muechler EK, Bonfiglio T, Choate J, Huang KE (1986) Pregnancy induced with menotropins in a woman with polycystic ovaries, endometrial hyperplasia, and adenocarcinoma. Fertil Steril 46:973–975
Paulson RJ, Sauer MV, Lobo RA (1990) Pregnancy after in vitro fertilization in a patient with stage I endometrial carcinoma treated with progestins. Fertil Steril 54:735–736
Lai CH, Hsueh S, Chao AS, Soong YK (1994) Successful pregnancy after tamoxifen and megestrol acetate therapy for endometrial carcinoma. Br J Obstet Gynaecol 101:547–549
Niwa K, Yokoyama Y, Tanaka T et al (1994) Successful pregnancy in a patient with endometrial carcinoma treated with medroxyprogesterone acetate. Arch Gynecol Obstet 255:91–94
Kimmig R, Strowitzki T, Müller-Höcker J et al (1995) Conservative treatment of endometrial cancer permitting subsequent triplet pregnancy. Gynecol Oncol 58:255–257
Kowalczyk CL, Malone J, Peterson EP et al (1999) Well differentiated endometrial adenocarcinoma in an infertility patient with later conception. J Reprod Med 44:57–60
Mitsushita J, Toshihiko T, Kato K et al (2000) Endometrial carcinoma remaining after term pregnancy following conservative treatment with medroxyprogesterone acetate. Gynecol Oncol 79:129–132
Pinto AB, Gopal MG, Herzog TJ et al (2001) Successful in vitro fertilization pregnancy after conservative management of endometrial cancer. Fertil Steril 76:826–829
Lowe MP, Bender D, Sood AK et al (2002) Two successful pregnancies after conservative treatment of endometrial cancer and assisted reproduction. Fertil Steril 77:188–189
Zuckerman B, Lavie O, Neuman M et al (1998) Endometrial stage I-grade II. Conservative treatment followed by a healthy twin pregnancy. Int J Gynecol Cancer 8:172–174
Huang SY, Jung SM, Ng KK et al (2005) Ovarian metastasis in a nulliparous woman with endometrial adenocarcinoma failing conservative hormonal treatment. Gynecol Oncol 97:652–655
Yasuda M, Matsui N, Kajiwara H et al (2004) Malignant transformation of atypical endometrial hyperplasia after progesterone therapy showing germ-cell tumor-like differentiation. Pathol Int 54:451–456
Ferrandina G, Zannoni GF, Gallotta V et al (2005) Progression of conservatively treated endometrial carcinoma after full term pregnancy: a case report. Gynecol Oncol 99:215–217
Ota T, Yoshida M, Kimura M, Kinoshita K (2005) Clinicopathologic study of uterine endometrial carcinoma in young women aged 40 years and younger. Int J Gynecol Cancer 15:657–662
Cormio G, Martino R, Loizzi V et al (2006) A rare case of choroidal metastasis presented after conservative management of endometrial cancer. Int J Gynecol Cancer 16:2044–2048
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Agustín, L.C.d., Sastre, F.L., Galán, V.C. et al. Conservative management of patients with early endometrial carcinoma: a systematic review. Clin Transl Oncol 10, 155–162 (2008). https://doi.org/10.1007/s12094-008-0173-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12094-008-0173-1