Fertility-Sparing Methods in Adolescents Affected by Endometrial Cancer: A Comprehensive Review

Abstract

Although in developed countries endometrial cancer (EC) is the most common gynecological malignancy, its occurrence in adolescents is exceedingly rare. The increasing rate of obesity in children and adolescents is held responsible for the increasing prevalence of EC in younger cohorts of patients. The diagnosis of this malignancy can have devastating consequences for future fertility because standard treatment protocols for EC include hysterectomy. Here, we present the first detailed review of the world literature on EC in subjects aged 21 years or younger (n = 19). The mean age at diagnosis was 16.7 ± 0.6 years. One patient (5.3%) had a Type II (high-risk) disease. No communication retrieved from the search reported on patient death; however, two (10.5%) patients were lost to follow-up. There was also a high proportion (five subjects, or 26.3%) of cases with genetic background (Cowden syndrome and Turner syndrome), therefore genetic screening or a direct genetic study should be considered in very young patients with EC. The current fertility-sparing options, limited to Type I (low-risk) disease, are presented and discussed. Such information, obtained from studies on older women, translates well to adolescent girls and very young women. Careful anatomopathological monitoring at follow-up is essential for the safety of a conservative approach. Improved survival in very young EC patients makes the preservation of fertility a central survivorship issue, therefore both patients and caregivers should undergo counseling regarding available options. Moreover, our study suggests that genetic syndromes other than Lynch syndrome may be associated with EC more frequently than previously thought.

Endometrial Cancer in Reproductive Age: Fertility-Sparing Approach and Reproductive Outcomes

“…Increasing rates of obesity among children and adolescents appear to be contributing to an increased incidence of EC among young patients [ 76 ]. Recently, investigators have evaluated if weight loss management could be a potential adjunct to HT among patients undergoing conservative EC treatment [ 77 ].…”

Antioxidative, Anti-Inflammatory, Anti-Obesogenic, and Antidiabetic Properties of Tea Polyphenols—The Positive Impact of Regular Tea Consumption as an Element of Prophylaxis and Pharmacotherapy Support in Endometrial Cancer

“…Gonadotropin-releasing hormone (GnRH) analogues or aromatase inhibitors have also been observed to be effective in the treatment of early-stage and highly differentiated tumours. The applicability of fertility-sparing treatment is limited only to patients with a low-risk disease [ 42 , 43 ].…”