Fertility-preservation in endometrial cancer: is it safe? Review of the literature
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Universidade Federal de Minas Gerais
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Resumo
Almost 5% of women with endometrial cancer are under age 40, and they often have well-differentiated en dometrioid estrogen-dependent tumors. Cancer survival rates have improved over the last decades so strategies to avoid or reduce the reproductive damage caused by oncologic treatment are needed. We reviewed the published literature to find evidence to answer the following questions: How should we manage women in reproductive age with endometrial cancer? How safe is fertility preservation in endometrial cancer? Can pregnancy influence endometrial cancer recurrence? What are the fertility sparing op tions available? Progestins may be prescribed after careful evaluation and counseling. Suitable patients should be se lected using imaging methods and endometrial sampling since surgical staging will not be performed. Conservative treatment should only be offered to patients with grade 1 well-differentiated tumors, absence of lymph vascular space invasion, no evidence of myometrial invasion, met astatic disease or suspicious adnexal masses, and expres sion of progesterone receptors in the endometrium. The presence of co-existing ovarian metastatic of synchronous cancer should be investigated and ruled out before the de cision to preserve the ovaries. The availability of Assisted Reproductive Technology (ART) has made it possible for women with endometrial cancer to give birth to a child without compromising their prognoses. Gamete, embryo or ovarian tissue cryopreservation techniques can be employed, although the latter remains experimental. Unfortu nately, fertility preservation is rarely considered. Current recommendations for conservative management are based on the overall favorable prognosis of grade 1 minimally invasive tumors. Selected patients with endometrial cancer may be candidates to a safe fertility-preserving management.
Abstract
Assunto
Técnicas de Reprodução Assistida, Neoplasias do Endométrio, Infertilidade Feminina
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Assisted reproductive technology, Cancer of the endometrium, Female infertility, Reproductive endocrinology
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https://www.jbra.com.br/trab/pub/detalhe_trabalho.php