Conservative management of endometrial cancer

Abstract

Endometrial cancer is the most common gynecologic malignancy in the United States. Approximately 54,000 new cases will be diagnosed in 2015, and the incidence of endometrial cancer has increased by 1.5% per year among women younger than 50 years, and by 2.6% per year among women 50 years and older. Fortunately, the overall mortality due to endometrial cancer remains low (ACS. American Cancer Society facts & figures 2015. American Cancer Society; 2015). Endometrial cancer is standardly treated with surgical resection via total hysterectomy (removal of the uterine corpus and cervix) and bilateral salpingo-oophorectomy, with or without lymph node assessment. However, given the rise in incident endometrial cancers largely related to the obesity epidemic, increasing numbers of young women with endometrial cancer will desire to preserve the uterus for fertility, and opt for conservative management. At the other end of the spectrum, a subset of patients with endometrial cancer may be unsuitable surgical candidates largely due to obesity and its related comorbid conditions and physical dysfunction. Both of these 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.