Fertility-sparing approach for endometrial cancer: the role of office hysteroscopy

Abstract

Endometrial cancer is the most common gynecologic malignancy in developed countries, with increasing incidence among younger, nulliparous patients. These epidemiological shifts are attributed to increasing rates of obesity, in combination with delayed childbearing. This highlights a need for fertility-sparing options for individuals who wish to delay standard surgical management with hysterectomy, bilateral salpingoophorectomy, and assessment of pelvic/para-aortic lymph nodes. Careful consideration should be taken to select which patients are suitable candidates for fertility-sparing methods. Typically, these are patients found to have FIGO grade 1 tumors of the endometrioid subtype without myometrial invasion. Currently, conservative treatment options include the use of oral progestins and levonorgestrel-releasing intrauterine devices, with an emerging role for hysteroscopy for direct visualization of the uterine cavity, targeted tissue sampling, and tumor resection. This paper aims to highlight the role of office hysteroscopy for diagnosis, hysteroscopic tumor resection, and follow-up in suitable endometrial cancer patients who wish to preserve their uterus until childbearing is complete.

Keywords:

• Endometrial cancer
• office hysteroscopy
• hysteroscopy
• fertility-sparing
• conservative management

Disclosure statement

The authors have no financial interests to disclose.

Additional information

Notes on contributors

José Carugno

Jose Carugno, Board Certified in Obstetrics and Gynecology, Fellowship Trained and Board Certified in Minimally Invasive Gynecologic Surgery. Minimally Invasive Gynecology and Robotic Division Director at the University of Miami, Miller School of Medicine, Miami, Florida, USA.

Adriana Wong

Adriana Wong is an Obstetrics and Gynecology Resident at California Davis Medical Center, Sacramento, California, USA.