Fertility-sparing hormonal treatment of early endometrial cancer
For young women with the earliest, low-grade endometrial cancers, progestin pills or a hormonal IUD can clear the cancer and allow pregnancy before a later hysterectomy.
Candidates: grade 1 endometrioid carcinoma confined to the endometrium on MRI, PR-positive, no myometrial invasion. Complete response ~70-80% at 12 months with oral megestrol/medroxyprogesterone or a levonorgestrel IUD (often combined with metformin or hysteroscopic resection); recurrence ~30%; live-birth rates ~30-40% with assisted reproduction. Hysterectomy after childbearing is recommended.
How it works
Progestin-induced differentiation and apoptosis of hormone-responsive endometrial cancer cells under close endometrial sampling surveillance.
- Preserves fertility in a disease increasingly diagnosed in women under 45
- Minimal toxicity
- Recurrence risk ~30%
- Requires strict imaging and biopsy follow-up
- Not appropriate for grade 2-3, p53-abnormal, or invasive disease
Latest papers
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