Endometrial Cancer Management in Young Women

Abstract

Endometrial cancer (EC) rarely develops in young women. Most cases are associated with known risk factors: BMI > 30, history of Polycystic Ovary Syndrome (PCOs), and race differentiation. The molecular EC classification based on The Cancer Genome Atlas Research Network divides these heterogeneous cancers into four types: Polymerase Epsilon Mutation (POLE), Microsatellite Instability (MSI), Copy Number Low (CNL), and Copy Number High (CNH). This division was introduced to allow for early assessment of neoplastic changes and clinical management, including targeted therapies. The basic technique for imaging endometrium changes is transvaginal sonography. Hysteroscopy is the standard for obtaining endometrial material for histological evaluation. The MRI result permits assessment of the extent of EC cancer infiltration. In young women who want to preserve fertility, apart from surgery, conservative management is often implemented after strict selection based on clinical and pathological data. This pharmacological treatment involves the administration of progestogens MPA (medroxyprogesterone acetate) and MA (megestrol acetate). The use of metformin may increase the effectiveness of such treatment. An alternative option is to apply progestogens locally—via the levonorgestrel-releasing intrauterine device. In addition to pharmacological treatment, hysteroscopic resection may be used—part of the uterine muscle adjacent to the pathologically changed endometrium may also undergo resection. An alternative is the administration of estrogen receptor modulators (e.g., SERMs) or aromatase inhibitors, or GnRH agonists.

Shared Pathogenic and Therapeutic Characteristics of Endometriosis, Adenomyosis, and Endometrial Cancer: A Comprehensive Literature Review

“…The EC risk stratification used in the treatment approach has been based on histological types. In 1983, Bokhman was the first to distinguish two types of EC [ 6 ]. Stage assignment is generally more objective, but trials have shown large inconsistencies and disagreements in grade, histology type, stage, or risk factors based on stromal invasion, myometrial invasion, or lymphovascular invasion (LVI).…”

“…While the precise mechanisms remain elusive, mutations in PTEN appear to influence cell cycle regulation, CTNNB1 mutations are associated with increased mobility and invasiveness, and mutations in PIK3CA (encoding the p110a catalytic subunit of PIK3) inhibit apoptosis. Furthermore, additional research has identified mutations in KRAS (Ki-ras 2 Kirsten rat sarcoma viral oncogene homolog), LOH (loss of heterozygosity), and BRAF (B-Raf murine sarcoma viral oncogene homolog B) within endometriotic lesions [ 1 , 3 , 6 , 11 , 16 ]. Additionally, endometriosis is recognized as a multifactorial disease, with evidence suggesting significant dysregulation of micro-RNA expression, mirroring its crucial role in cancer development [ 1 , 11 ].…”

“…This is a widely studied epigenetic process associated with the repression of gene activity. Epigenetic and genetic theories are currently being investigated to identify potential therapeutic targets [ 1 , 3 , 6 ].…”

“…A continuous increase in the incidence of EC (endometrial cancer) has been observed. In highly developed countries, this is probably due to the tendency toward late motherhood [ 6 ]. EC is the most common gynecological cancer in the USA, with its incidence rising [ 6 , 7 ].…”

“…In highly developed countries, this is probably due to the tendency toward late motherhood [ 6 ]. EC is the most common gynecological cancer in the USA, with its incidence rising [ 6 , 7 ]. Patients with advanced and recurrent EC are a major therapeutic challenge [ 8 ].…”