NEOPLASIA and FERTILITY

Endometrial Cancer and Fertility

Author(s): Angiolo Gadducci* and Roberta Tana

Pp: 53-74 (22)

DOI: 10.2174/9789815050141122010004

* (Excluding Mailing and Handling)

Abstract

Endometrial carcinoma is the most common gynecological malignancy in the western countries. Although majority of patients are postmenopausal, 2.5–14.4% of the cases are detected in women aged <40 years. The tumors diagnosed in young women are usually early-stage, low-grade endometrioid endometrial carcinoma [EEC]s with favorable clinical outcomes. The standard primary therapy consists of extra-fascial hysterectomy and bilateral salpingo-oophorectomy with or without node dissection. However, a fertility-sparing treatment is feasible in accurately selected young women with complex atypical hyperplasia or with EEC with G1 tumor limited to the endometrium. According to some authors, the conservative approach can be taken into consideration also in patients with stage IA, G2-3 EEC without myometrial invasion and in those with stage IA, G1 EEC with superficial myometrial invasion. After hysteroscopic resection of the lesion and the underlying myometrium, the woman istreated with anoral progestin at adequate doses or a progestin-releasing –IUD with or without Gn-RH agonists, and she undergoes the first biopsy after 3 months. In the case of a positive biopsy, the patient continues progestin therapy for additional 3 months, but if the 6-months biopsy is still positive, hysterectomy is recommended. Several women become pregnant with the aid of assisted reproductive technologies. An accurate follow-up is also needed after a successful pregnancy, whereas the debate that the opportunity of performing hysterectomy after childbearing potential is no longer required.


Keywords: Assisted reproductive technology, Endometrial cancer, Endometrial complex atypical hyperplasia, Fertility-sparing treatment, Gonadotrophinreleasing hormone agonist (Gn-RH), Medroxyprogesterone acetate, Megestrol acetate, Pregnancy, Progestins.

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      • 11. app/Models/ContentAccess.php:647
      • 12. app/Http/Controllers/ChapterController.php:1478
      • 13. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
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      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1518
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 314566706 and j.to_ip >=314566706 )) and ((j.from_date <= 1739835005 and j.to_date >= 1739835005 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 17870) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 314566706 and j.to_ip >=314566706 )) and ((j.from_date <= 1739835005 and j.to_date >= 1739835005 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 17870) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 314566706 and j.to_ip >=314566706 )) and ((j.from_date <= 1739835005 and j.to_date >= 1739835005 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 17870)
      740μsalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 3410 and `b`.`banner_from_date` <= 1739835005 and `b`.`banner_to_date` >= 1739835005 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.18msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 3410
      • 3: 1739835005
      • 4: 1739835005
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='2b0855ab220b16f1d54b0e08aff78fd1'
      310μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    9Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        wyOystid2ZYVkLiVmjT1khVyI4Jc7k8ua7GauRuC
        uc_cart_id
        2b0855ab220b16f1d54b0e08aff78fd1
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/17870" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/17870
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
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        request_cookies
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        response_headers
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        ClearShow all
        Date ↕MethodURLData
        #12025-02-17 23:30:05GET/chapter/178701121911