Fertility preservation in women with endometrial cancer
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memo https://doi.org/10.1007/s12254-020-00661-6
Fertility preservation in women with endometrial cancer Helena Bralo · Maria Roethlisberger · Kazem Nouri
Received: 14 April 2020 / Accepted: 30 September 2020 © Springer-Verlag GmbH Austria, part of Springer Nature 2020
Summary Fertility preservation should only be offered to patients with endometrial cancer stage Ia grade 1 (G1), who present without myometrial invasion or where the cancer has invaded less than 50% of the myometrium, with no evidence of pathological lymph nodes or no evidence of synchronous or metachronous ovarian tumor. It is estimated that about 22% will achieve successful pregnancy. Keywords Oncofertility · Endometrial neoplasms · Pregnancy · Live birth rate · Family planning
and diabetes mellitus type 2 as a consequence of obesity [9]. The most common type of endometrial cancer in premenopausal women is the estrogen-sensitive adenocarcinoma (type I carcinoma). The presence of two or more polyps in patients with PCOS already increases the probability of premalignant and malignant changes [10]. There is a subgroup of young women without typical risk factors (normal weight, regular menstruation) who are affected by endometrial cancer as well. These women tend to have a type II carcinoma with more aggressive growth and worse outcome [11].
Introduction
Diagnosis
Endometrial cancer affects 9 per 100,000 women worldwide, and approximately 11,090 women are newly diagnosed every year in Europe [1, 2]. The majority of affected women are over 50 years of age, with 20% being premenopausal, 14% are under 45 years old, while 5% are less than 40 years old [3, 4]. Over 70% of these women are nulliparous at the time of diagnosis [5–7]. For these women, family planning is still an option. In this case, fertility preservation for these women plays an important role. The important risk factor for endometrial cancer is a hyperestrogenic state, caused by irregular cycles, anovulation, often seen in patients with polycystic ovary syndrome (PCOS) [8]. Infertility and nulliparity contribute to that state, as well as hypertension
Most patients are diagnosed at an early stage of disease, resulting in an elevated 5-year survival rate of 93% [10]. The most common symptom is irregular vaginal bleeding. Hysteroscopy and endometrial biopsy are the gold standard method for patients with endometrial cancer undergoing fertility preservation, with a sensitivity of 84% and a specificity of 99.2% [12]. Biopsy alone is not recommended, as there is the risk of missed lesions, and consequently, underdiagnosis. According to the NICE (The National Institute for Health and Care Excellence) guidelines, hysteroscopy should only be offered to premenopausal patient after failure of conservative treatment [13]. The American College of Obstetricians and Gynecologists recommends immediate referral to hysteroscopy in cases with risk factors, such as age and obesity [14]. In a meta-analysis conducted by Pennant et al., the risk of endometrial cancer in premenopausal women with irregular ble
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