Role of hysteroscopy during conservative management of atypical endometrial hyperplasia and early-stage endometrial cancer in patients who desire pregnancy

Abstract

Twenty-five percent of cases of endometrial cancer appear in women with unfulfilled reproductive desires. An adequate selection of patients and a close hysteroscopic follow-up to monitor the endometrial response to the levonorgestrel-releasing intrauterine system (LNG-IUS) may be a valid and safe option for these patients. This is a case series and review of the literature study. We included eight patients diagnosed of complex endometrial hyperplasia with atypia (CEHA) or stage 1AG1 well-differentiated endometrial cancer without myometrial invasion who desired to get pregnant and opted for a conservative treatment. Follow-up was performed with hysteroscopy and directed biopsy at 3, 6 and 12 months. Of the 854 cases of complex endometrial hyperplasia with atypia (CEHA)/endometrial cancer were diagnosed, 2.3% were candidates for conservative management. We obtained a favourable regression of 71.2% at 6 months and 57% at one year with hormonal treatment. Conservative treatment in complex endometrial hyperplasia with atypia (CEHA)/low-grade endometrial cancer in reproductive age patients with a strong desire for pregnancy is feasible.

Keywords:

• Low-grade endometrial cancer
• complex endometrial hyperplasia
• atypia
• hysteroscopy
• LNG-IUS
• fertility

Acknowledgements

We would like to thank the Gynecological Oncology Unit and the Pelvic Oncology Committee of the Hospital Materno Infantil de Canarias for their work in the integral care of these patients, as they have promoted the conservative management of this pathology in our center. We would also like to thank the native English teacher, Peter Mangiaracina and English teacher Patricia Martín for the translation of this article.

Ethical approval

The patients understood, accepted and signed the informed consent.

Disclosure statement

The authors declare that there is no conflict of interest.