Please wait a minute...
European Journal of Gynaecological Oncology  2020, Vol. 41 Issue (3): 476-479    DOI: 10.31083/j.ejgo.2020.03.5195
Case Report Previous articles | Next articles
Safe fertility-preserving management in a young woman with endometrial cancer
S. Liu1, F. Ruan1, M. Shi1, Y. Liu1, W. Li1, B. Bi1, H. Wang2, W. Lv1()
1Department of Gynecology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
2Department of Gynecology and Obstetrics, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
Download:  PDF(716KB)  ( 337 ) Full text   ( 14 )
Export:  BibTeX | EndNote (RIS)      
Abstract  

Endometrial cancer (EC) is a malignant cancer originating from the uterine endometrium. Although the incidence of endometrial cancer in reproductive age is relatively low, its impact on pregnancy outcome is critical. To date, it is difficult to find a standard method which can be referred to these patients who have a strong desire to preserve fertility. Presented is a report of a 35-year-old women with early-stage Endometrial cancer treated with progestin and levonorgestrel-releasing intrauterine system (LNG-IUS) with a good prognosis.

Key words:  Endometrial cancer      Fertility-preserving      Progestin      Levonorgestrel-releasing intrauterine system     
Submitted:  14 February 2019      Accepted:  03 June 2019      Published:  15 June 2020     
Fund: JBZX-201803/Focused Center of Intrauterine Disease Of Zhejiang Province, Center for Uterine Cancer Diagnosis & Therapy Research in Zhejiang Province;2017-XK-A25/Combination of the traditional Chinese and western medicine of Zhejiang Province
*Corresponding Author(s):  W. Lv     E-mail:  ww4021@163.com

Cite this article: 

S. Liu, F. Ruan, M. Shi, Y. Liu, W. Li, B. Bi, H. Wang, W. Lv. Safe fertility-preserving management in a young woman with endometrial cancer. European Journal of Gynaecological Oncology, 2020, 41(3): 476-479.

URL: 

https://ejgo.imrpress.com/EN/10.31083/j.ejgo.2020.03.5195     OR     https://ejgo.imrpress.com/EN/Y2020/V41/I3/476

Figure 1.  — A) Ultrasonic image shows the highly thickened endometrial wall. B) Hysterosalpingographic image shows highly thickened and diffuse irregularity of the endometrial wall. C) Histopathologic findings of hysteroscopic endometrial biopsy. Slides demonstrate well-differentiated grade I endometrioid adenocarcinoma (H&E stain, ×200). D) Images obtained using pelvic MRI. Sagittal image reveals no myometrial invasion and a mass-like lesion in the uterine cavity, but with no significant lymph node enlargement. E) Complete remission was achieved in endometrial thickness of uterus after six months of treatments.

[1] Biler A., Solmaz U., Erkilinc S., Gokcu M., Bagci M., Temel O., et al.: “Analysis of endometrial carcinoma in young woman at a high-volume cancer center”. Int. J. Surg., 2017, 44, 185.
doi: 10.1016/j.ijsu.2017.06.083 pmid: 28673864
[2] Kalogera E., Dowdy S.C., Bakkum Gamez J.N.: “Preserving fertility in young patients with endometrial cancer: current perspectives”. Int. J. Womens Health, 2014, 6, 691.
doi: 10.2147/IJWH.S47232 pmid: 25114594
[3] Duska L.R., Garrett A., Rueda B.R., Haas J., Chang Y., Fuller A.F.: “Endometrial cancer in women 40 years old or younger”. Gynecol. Oncol., 2001, 83, 388.
doi: 10.1006/gyno.2001.6434 pmid: 11606102
[4] Kim S.W., Kim H., Ku S.Y., Suh C.S., Kim S.H., Choi Y.M.: “A successful live birth with in vitro fertilization and thawed embryo transfer after conservative treatment of recurrent endometrial cancer”. Gynecol. Endocrinol., 2017, 34, 1.
doi: 10.1080/09513590.2017.1381682 pmid: 28980832
[5] Tomao F., Peccatori F., Del Pup L., Franchi D., Zanagnolo V., Panici P.B., et al.: “Special issues in fertility preservation for gynecologic malignancies”. Crit. Rev. Oncol. Hematol., 2016, 97, 206.
doi: 10.1016/j.critrevonc.2015.08.024 pmid: 26358422
[6] Bradford L.S., Rauh Hain J.A., Schorge J., Birrer M.J., Dizon D.S.: “Advances in the management of recurrent endometrial carcinoma”. Am. J. Clin. Oncol., 2015, 8, 206.
[7] Gallos I.D., Yap J., Rajkhowa M., Luesley D.M., Coomarasamy A., Gupta J.K.: “Regression, relapse, and live birth rates with fertility-sparing therapy for endometrial cancer and atypical complex endometrial hyperplasia: a systematic review and metaanalysis”. Am. J. Obstet. Gynecol., 2012, 207, 1.
doi: 10.1016/j.ajog.2012.05.018 pmid: 22727343
[8] Park J.Y., Kim D.Y., Kim J.H., Kim Y.M., Kim K.R., Kim Y.T., et al.: “Long-term oncologic outcomes after fertility-sparing management using oral progestin for young women with endometrial cancer (KGOG. 2002)”. Eur. J. Cancer, 2013, 49, 868.
doi: 10.1016/j.ejca.2012.09.017
[9] Saegusa M., Okayasu I.: “Progesterone therapy for endometrial carcinoma reduces cell proliferation but does not alter apoptosis”. Cancer, 1998, 83, 111.
doi: 10.1002/(sici)1097-0142(19980701)83:1<111::aid-cncr15>3.0.co;2-# pmid: 9655300
[10] Mentrikoski M.J., Shah A.A., Hanley K.Z., Atkins K.A.: “Assessing endometrial hyperplasia and carcinoma treated with progestin therapy”. Am. J. Clin. Pathol., 2012, 138, 524.
doi: 10.1309/AJCPM2TSDDF1MHBZ
[11] Gunderson C.C., Fader A.N., Carson K.A., Bristow R.E.: “Oncologic and Reproductive outcomes with progestin therapy in women with endometrial hyperplasia and grade 1 Adenocarcinoma: A systematic review”. Gynecol. Oncol., 2012, 125, 477.
doi: 10.1016/j.ygyno.2012.01.003
[12] Ushijima K., Yahata H., Yoshikawa H., Konishi I., Yasugi T., Saito T., et al.: “Multicenter phase II study of fertility-sparing treatment with medroxyprogesterone acetate for endometrial carcinoma and atypical hyperplasia in young women”. J. Clin. Oncol., 2007, 25, 2798.
doi: 10.1200/JCO.2006.08.8344 pmid: 17602085
[13] Gunderson C.C., Fader A.N., Carson K.A., Bristow R.E.: “Oncologic and reproductive outcomes with progestin therapy in women with endometrial hyperplasia and grade 1 adenocarcinoma: a systematic review”. Gynecol. Oncol., 2012, 125, 477.
doi: 10.1016/j.ygyno.2012.01.003
[14] Park J.Y., Nam J.H.: “Progestins in the fertility-sparing treatment and retreatment of patients with primary and recurrent endometrial cancer”. Oncologist, 2015, 20, 270.
doi: 10.1634/theoncologist.2013-0445 pmid: 25673106
[15] Qin Y., Yu Z., Yang J., Cao D., Yu M., Wang Y., Shen K.: “Oral Progestin Treatment for Early-Stage Endometrial Cancer:A Systematic Review and Meta-analysis”. Int. J. Gynecol. Cancer, 2016, 26, 1081.
doi: 10.1097/IGC.0000000000000723 pmid: 27177279
[16] Kalogera E., Dowdy S.C., Bakkum Gamez J.N.: “Preserving fertility in young patients withendometrial cancer: current perspectives”. Int. J. Womens Health, 2014, 29, 691.
[17] Mi La Kim, Seok Ju Seong.: “Clinical applications of Levonorgestrel-releasing intrauterine system to gynecologic diseases”. Obstet. Gynecol. Sci., 2013, 56, 67.
doi: 10.5468/OGS.2013.56.2.67 pmid: 24327984
[18] Heikinheimo O., Gemzell Danielsson K.: “Emerging indications for the levonorgestrel-releasing intrauterine system (LNG-IUS)”. Acta Obstet. Gynecol. Scand., 2012, 91, 3.
doi: 10.1111/j.1600-0412.2011.01303.x pmid: 22007693
[19] Zhou H., Cao D., Yang J., Shen K., Lang J.: “Gonadotropin-Releasing Hormone Agonist Combined with a Levonogestrel-releasing intrauterine system or letrozole for fertility-preserving treatment of endometrialcarcinoma and complex atypical hyperplasia in young women”. Int. J. Gynecol. Cancer, 2017, 27, 1178.
doi: 10.1097/IGC.0000000000001008 pmid: 28562472
[20] Karimi Zarchi M., Mousavi A.S., Behtash N., Chiti Z., Bokaie M.: “Conservative management of young women with endometrial carcinoma or complex atypicalhyperplasia: report of three cases and literature review”. Eur. J. Gynaecol. Oncol., 2011, 32, 695
[21] Kim S.W., Kim H., Ku S., Suh C.S., Kim S.H., Choi Y.M.: “A successful live birth with in vitro fertilization and thawed embryo transfer after conservative treatment of recurrent endometrial cancer”. Gynecol. Endocrinol., 2018, 34, 15.
doi: 10.1080/09513590.2017.1342239 pmid: 28650773
[22] Falcone F., Laurelli G., Losito S., Di Napoli M., Granata V., Greggi S.: “Fertility preserving treatment with hysteroscopic resection followed by progestin therapy in young women with early endometrial cancer”. J. Gynecol. Oncol. , 2017, 28, 2
[23] De Marzi P., Bergamini A., Luchini S., Petrone M., Taccagni G.L., Mangili G., et al.: “Hysteroscopic Resection in Fertility-Sparing Surgery for Atypical Hyperplasia and Endometrial Cancer: Safety and Efficacy”. J. Minim. Invasive Gynecol., 2015, 22, 1178.
doi: 10.1016/j.jmig.2015.06.004 pmid: 26092080
[24] Gotlieb W.H., Beiner M.E., Shalmon B., Korach Y., Segal Y., Zmira N., et al.: “Outcome of fertility-sparing treatment with progestins in young patients with endometrial cancer”. Obstet. Gynecol., 2003, 102, 718.
doi: 10.1016/s0029-7844(03)00667-7 pmid: 14551001
[25] Park JY., Nam J.H.: “Progestins in the fertility-sparing treatment and retreatment of patients with primary and recurrent endometrial cancer”. Oncologist, 2015, 20, 270.
doi: 10.1634/theoncologist.2013-0445 pmid: 25673106
[26] Kalogera E., Dowdy S.C., Bakkum Gamez J.N.: “Preserving fertility in young patients with endometrial cancer:current perspectives”. Int. J. Womens Health, 2014, 6, 691.
doi: 10.2147/IJWH.S47232 pmid: 25114594
[27] Gamadauro P., Gudmundsson J.: “Endometrial cancer in a woman undergoing hysteroscopy for recurrent IVF failure”. Gyncecol. Surg., 2017, 14, 4.
[28] Nougaret S., Lakhman Y., Vargas HA., Colombo PE., Fujii S., Rein hold C. Sala E.: “From Staging to Prognostication Achievement and challenges of MR Imaging in the Assessment of endometrial cancer”. Magn. Reson. Imaging Clin N. Am., 2017, 25, 611.
doi: 10.1016/j.mric.2017.03.010 pmid: 28668163
[29] Morice P., Leary A., Creutzberg C., Abu Rustum N., Darai E.: “Endometrial cancer”. Lancet, 2016, 387, 1094.
[1] Ikuji Shimazaki, Yasunori Hashiguchi, Makoto Yamauchi, Mari Kasai, Takeshi Fukuda, Tomoyuki Ichimura, Tomoyo Yasui, Toshiyuki Sumi. Secondary small cell vaginal cancer after operative therapy for endometrial cancer[J]. European Journal of Gynaecological Oncology, 2020, 41(5): 821-823.
[2] Yu Hui Lim, Sheow Lei Lim, Linda Xiao Hui Lin, Lay Tin Soh, Hoon Seng Khoo Tan, Richard Ming Chert Yeo, Timothy Yong Kuei Lim. Sequential Chemoradiation versus Radiation for the Adjuvant Treatment of Stage III Endometrioid Adenocarcinoma of the Uterus[J]. European Journal of Gynaecological Oncology, 2020, 41(5): 705-712.
[3] Eda Kucuktulu, Ahmet Fatih Yurekli. Simultaneous Integrated Intensity Modulated Radiotherapy Boost for Gynecological Cancer when Brachytherapy is not an Option[J]. European Journal of Gynaecological Oncology, 2020, 41(5): 720-725.
[4] Michelle F. Benoit, Kristy K. Ward. Uterine Cancer Normogram to Predict Lymph Node Metastasis: Comparison to the Mayo Algorithm and an External Validation of a Model in a North American Population[J]. European Journal of Gynaecological Oncology, 2020, 41(5): 681-684.
[5] Yusuf Cakmak, Tufan Oge. The effect of age on prediction of concurrent endometrial cancer in patients with atypical endometrial hyperplasia[J]. European Journal of Gynaecological Oncology, 2020, 41(4): 531-535.
[6] Di Wu, Jirui Zhang, Chengxi Yang. Effect of letrozole combined with testosterone on the proliferation and apoptosis of endometrial carcinoma cells[J]. European Journal of Gynaecological Oncology, 2020, 41(4): 604-608.
[7] B.-H. Zhang, L. Li, J. Ji, J. Guo, X.-L. Zhou, H. Xu, F. Cao, X.-H. Tong. Prognostic value of Foxp3+ regulatory T cells in endometrial cancer: a meta-analysis[J]. European Journal of Gynaecological Oncology, 2020, 41(3): 339-342.
[8] J.Y. Chen, Z.Q. Wang, S.C. Liang, H.Y. Hou, D.B. Chen, J.L. Wang. Sentinel lymph node mapping with carbon nanoparticles in endometrial cancer[J]. European Journal of Gynaecological Oncology, 2020, 41(3): 408-414.
[9] J. Feng, J. Wu, M. Zhang, J. Wang, K. Chen, X. Li, J. Xie, J. Zhang, C. Wang. Oleic acid promotes the development of endometrial cancer by up-regulating KLF4 expression[J]. European Journal of Gynaecological Oncology, 2020, 41(3): 432-438.
[10] K. Plagens–Rotman, M. Piskorz–Szymendera, B. PIĘTA. Lifestyle with particular emphasis on physical activity and genital carcinomas in women[J]. European Journal of Gynaecological Oncology, 2020, 41(2): 233-239.
[11] X.Q. Wang, S.Q. Ma, J.Y. Guo, F. Zhao, X.H. Liang. Characteristics and prognostic factors among premenopausal versus postmenopausal patients with advanced endometrial cancer: a SEER-based analysis[J]. European Journal of Gynaecological Oncology, 2020, 41(1): 1-6.
[12] S. Srdelić Mihalj, V. Čapkun, I. Kuzmić-Prusac. High-grade endometrial cancer survival (endometrioid to non-endometrioid histology comparison)[J]. European Journal of Gynaecological Oncology, 2020, 41(1): 16-22.
[13] Y.-S. Kwon, K. S. Im, S. B. Yoo, W. I. Kim. Two cases of uterus-conserving treatment for early stage endometrial cancer[J]. European Journal of Gynaecological Oncology, 2020, 41(1): 145-147.
[14] T. Wada, Y. Hashiguchi, M. Kasai, T. Fukuda, T. Ichimura, T. Yasui, T. Sumi. HMGCR antibody-associated myopathy in patient with endometrial cancer: a rare case[J]. European Journal of Gynaecological Oncology, 2020, 41(1): 148-150.
[15] M. Englert-Golon, B. Burchardt, R. Słopień, N. Smolarek, S. Sajdak. Ovarian and endometrial cancer after breast cancer - three primary malignancies in a single patient[J]. European Journal of Gynaecological Oncology, 2020, 41(1): 153-154.
No Suggested Reading articles found!