Fertility-preservation in endometrial cancer: is it safe? Review of the literature

Abstract

Almost 5% of women with endometrial cancer are under age 40, and they often have well-differentiated endometrioid estrogen-dependent tumors. Cancer survival rates have improved over the last decades so strategies to avoid or reduce the reproductive damage caused by oncologic treatment are needed. We reviewed the published literature to find evidence to answer the following questions: How should we manage women in reproductive age with endometrial cancer? How safe is fertility preservation in endometrial cancer? Can pregnancy influence endometrial cancer recurrence? What are the fertility sparing options available? Progestins may be prescribed after careful evaluation and counseling. Suitable patients should be selected using imaging methods and endometrial sampling since surgical staging will not be performed. Conservative treatment should only be offered to patients with grade 1 well-differentiated tumors, absence of lymph vascular space invasion, no evidence of myometrial invasion, metastatic disease or suspicious adnexal masses, and expression of progesterone receptors in the endometrium. The presence of co-existing ovarian metastatic of synchronous cancer should be investigated and ruled out before the decision to preserve the ovaries. The availability of Assisted Reproductive Technology (ART) has made it possible for women with endometrial cancer to give birth to a child without compromising their prognoses. Gamete, embryo or ovarian tissue cryopreservation techniques can be employed, although the latter remains experimental. Unfortunately, fertility preservation is rarely considered. Current recommendations for conservative management are based on the overall favorable prognosis of grade 1 minimally invasive tumors. Selected patients with endometrial cancer may be candidates to a safe fertility-preserving management.

Can preoperative magnetic resonance imaging replace intraoperative frozen sectioning in the evaluation of myometrial invasion for early-stage endometrial carcinoma?

“…Some patients cannot be operated on due to advanced age, morbid obesity, and/or medical comorbidities [2,17]. In addition, some young patients wish to preserve their fertility [2,28]. Thus, surgical staging cannot be performed and intra-abdominal or extrauterine spread of the disease cannot be seen in these cases.…”

The survival effect of ovary preservation in early stage endometrial cancer: a single institution retrospective analysis

“…There are many reports of ovarian function deterioration after radiation or chemotherapy in premenopausal women [20][21][22][23]. These cases demonstrate that preserving the ovaries does not result in Endometrial cancer in premenopausal women has been shown to be hormone related, have early stage, no myometrial invasion, and good prognosis [24]. If metastatic or synchronous malignancy has not been found in the ovary during surgery, ovarian preservation may be performed; therefore, surgical menopause of the patient is not induced, which may be more beneficial to women's health.…”

Preservação da Fertilidade em Mulheres Jovens com Carcinoma do Endométrio: A Propósito de um Caso Clínico

“…13 Em diversos estudos de tratamento com progestativos a eficácia atinge valores de cerca de 90%. 14 As doentes devem ser criteriosamente selecionadas com base no grau de diferenciação do tumor G1 e tipo histoló-gico endometrioide, no estádio avaliado em RM sem invasão do miométrio e na ausência de invasão linfovascular, e devem ser devidamente informadas de que o tratamento adequado nestas situações é a histerectomia total com anexectomia bilateral, devendo estar dispostas a aceitar os riscos inerentes ao tratamento conservador.…”

“…A eficácia destes regimes varia de 26% a 89% nos casos de tumores que expressam recetores de estrogénio e progesterona. [8][9][10][11][12][13][14] Como alternativa, alguns estudos reportam que a utilização do dispositivo intrauterino com levonorgestrel (SIU) pode obter respostas entre 40% a 100% nas mulheres pré-menopáusicas com estádios precoces de CE bem diferenciado, [9][10][11][12] havendo uma meta-análise que demonstrou menores efeitos secundários do SIU (menor aumento de peso, menos alterações do sono, do humor e da libido, menos enxaquecas), quando comparado com os progestativos orais. 11 As recidivas são frequentes e podem atingir os 50%.…”