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Conservative Management of Endometrial Cancer

  • Living reference work entry
  • First Online:
Handbook of Gynecology

  • 12 Accesses

Abstract

Endometrial cancer is the most common gynecologic malignancy in the United States. Approximately 66,570 new cases will be diagnosed in 2021, and the incidence of endometrial cancer has increased by 1% per year. Fortunately, the overall mortality due to endometrial cancer remains low, but it has risen steadily in the last few decades at a rate of 2% per year (ACS, American Cancer Society facts & figures 2021; American Cancer Society; 2021). Endometrial cancer is standardly treated with surgical resection via total hysterectomy (removal of the uterine corpus and cervix) and bilateral salpingo-oophorectomy (TH-BSO), with or without lymph node assessment. However, given the rise in incident endometrial cancers, largely related to the obesity epidemic, increasing numbers of young premenopausal women diagnosed with endometrial cancer will desire to preserve the uterus for fertility and therefore opt for conservative management. Additionally, a subset of patients with endometrial cancer may be unsuitable surgical candidates, again often due to obesity and its related comorbid conditions as well as physical dysfunction. Both patient populations present a challenging management dilemma because surgery may not be a primary treatment option. Instead, conservative management of endometrial cancer based largely on hormonal therapy may be considered. While this approach is not standard of care, there is increasing evidence supporting the safety and efficacy of conservative therapy, particularly for low-grade, early-stage endometrial cancers. This evidence, however, must be tempered by the relative high recurrence rates and goal of subsequent hysterectomy when feasible.

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Abbreviations

CR:

complete response

D&C:

dilation and curettage

EMB:

endometrial biopsy

LNG-IUD:

levonorgestrel intrauterine device

MA:

megestrol acetate

MPA:

medroxyprogesterone acetate

PCOS:

polycystic ovarian syndrome

TH-BSO:

total hysterectomy bilateral salpingo-oophorectomy

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Pennsylvania Hospital, Philadelphia, PA, USA

    Alexandra Huttler

  2. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health System, Philadelphia, PA, USA

    Emily M. Ko

  3. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Novant Health Cancer Institute, New Hanover, NC, Wilmington, USA

    Lindsey Buckingham

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  1. Alexandra Huttler
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  2. Lindsey Buckingham
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  3. Emily M. Ko
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Correspondence to Emily M. Ko .

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Editors and Affiliations

  1. Department of Obstetrics and Gynecology and Family Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA

    Donna Shoupe

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Huttler, A., Buckingham, L., Ko, E.M. (2023). Conservative Management of Endometrial Cancer. In: Shoupe, D. (eds) Handbook of Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-319-17002-2_4-2

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