Ovarian conservation for young women with early-stage, low-grade endometrial cancer: a 2-step schema.

Abstract

In 2020, endometrial cancer continues to be the most common gynecologic malignancy in the United States. The majority of endometrial cancer is low grade, and nearly 1 of every 8 low-grade endometrial cancer diagnoses occurs in women younger than 50 years with early-stage disease. The incidence of early-stage, low-grade endometrial cancer is increasing particularly among women in their 30s. Women with early-stage, low-grade endometrial cancer generally have a favorable prognosis, and hysterectomy-based surgical treatment alone can often be curative. In young women with endometrial cancer, consideration of ovarian conservation is especially relevant to avoid both the short-term and long-term sequelae of surgical menopause including menopausal symptoms, cardiovascular disease, metabolic disease, and osteoporosis. Although disadvantages of ovarian conservation include failure to remove ovarian micrometastasis (0.4%-0.8%), gross ovarian metastatic disease (4.2%), or synchronous ovarian cancer (3%-5%) at the time of surgery and the risk of future potential metachronous ovarian cancer (1.2%), ovarian conservation is not negatively associated with endometrial cancer-related or all-cause mortality in young women with early-stage, low-grade endometrial cancer. Despite this, utilization of ovarian conservation for young women with early-stage, low-grade endometrial cancer remains modest with only a gradual increase in uptake in the United States. We propose a framework and strategic approach to identify young women with early-stage, low-grade endometrial cancer who may be candidates for ovarian conservation. This evidence-based schema consists of a 2-step assessment at both the preoperative and intraoperative stages that can be universally integrated into practice.

• Authors: Koji Matsuo, Rachel S Mandelbaum, Shinya Matsuzaki, Maximilian Klar, Lynda D Roman, Jason D Wright
• Journal: American journal of obstetrics and gynecology (Am J Obstet Gynecol) Vol. 224 Issue 6 Pg. 574-584 (06 2021) ISSN: 1097-6868 [Electronic] United States
• PMID: 33412129 (Publication Type: Journal Article)
• Copyright: Copyright © 2021 Elsevier Inc. All rights reserved.

Topics

• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Carcinoma, Endometrioid (diagnosis, pathology, surgery)
• Clinical Decision-Making (methods)
• Endometrial Neoplasms (diagnosis, pathology, surgery)
• Female
• Fertility Preservation (methods)
• Humans
• Hysterectomy (methods)
• Menopause
• Middle Aged
• Neoplasm Grading
• Neoplasm Metastasis
• Neoplasm Recurrence, Local (diagnosis, etiology, prevention & control)
• Neoplasm Staging
• Organ Sparing Treatments (methods)
• Ovarian Neoplasms (diagnosis, secondary, surgery)
• Ovariectomy (adverse effects)
• Perioperative Care (methods)
• Risk Assessment