Approximately 15% of patients with endometrial cancer are premenopausal. Previous studies largely support the conservative treatment of endometrial cancer in women desiring future fertility. From these studies, 75% to 80% of patients demonstrate a complete response to progestin therapy and the average recurrence rate is 30% to 35%. Conservative therapy should be reserved for women with International Federation of Gynecology and Obstetrics grade I tumors. Before conservative management, patients should be informed of the elevated risk (11%–29%) of concurrent ovarian cancer in cases of premenopausal endometrial cancer, and screening and ongoing surveillance during the treatment period is mandatory. A suggestion of myometrial invasion or metastatic disease is a contraindication to conservative management. Individuals meeting criteria for Lynch syndrome testing should be referred to genetic counseling. Fertility treatment should be individualized, and close surveillance is required during treatment. Staging hysterectomy is recommended after the completion of the childbearing period.
Obstetricians & Gynecologists, Family Physicians
After participating in this activity, physicians should be better able to select appropriate candidates with endometrial cancer for fertility-sparing treatment. Educate patients with endometrial cancer regarding the risks and benefits of standard of care therapy and conservative therapy and screen appropriate patients for lynch syndrome.
*Clinical Fellow, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Utah; †Attending Physician, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Huntsman Cancer Institute/University of Utah and University of Utah School of Medicine; ‡Resident, Department of Obstetrics and Gynecology, Huntsman Cancer Institute/University of Utah; §Genetic Counselor, Huntsman Cancer Institute/University of Utah; ¶Attending Physician, Division of Reproductive Endocrinology and Infertility, and Chairman, Department of Obstetrics and Gynecology, University of Utah; ∥Attending Physician, Division Director, Department of Gynecologic Oncology, Department of Obstetrics and Gynecology, Huntsman Cancer Institute/University of Utah, Salt Lake City, UT
Chief Editor's Note: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA Category 1 Credits™ can be earned in 2011. Instructions for how CME credits can be earned appear on the last page of the Table of Contents.
The authors, faculty, and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interest in, any commercial organizations pertaining to this educational activity.
Correspondence requests to: Andrew P. Soisson, MD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Huntsman Cancer Institute/University of Utah, 30N, 1900E, Suite 2B200, Salt Lake City, UT 84132. E-mail: firstname.lastname@example.org.