Outcome of fertility-preserving treatment in young women with endometrial carcinomas

OBJECTIVE: To evaluate the outcome of conservative treatment of young women with endometrial cancer. DESIGN: Observational study. SETTING: Gifu University Hospital, Japan from 1988 to 2002. POPULATION: Twelve women with endometrial cancer, FIGO IA estimated by MRI under 35 years. METHODS: Patients were treated with medroxyprogestreone acetate (400-600 mg/day) for 6-10 months, with endometrial curettage performed every four weeks. MAIN OUTCOME MEASURES: Response to therapy, pregnancies and reoccurrence of disease during follow up over a 30-month period. RESULTS: All cases had pathological complete remissions within 6-10 months. Seven of 10 wishing to have babies conceived, and five of them were delivered of full-term babies. Eight of nine cases receiving long term follow up (over 30 months) developed recurrent disease, with four opting for hysterectomy. No patient developed distant metastases or had disease-related death. CONCLUSION: Conservative therapy is feasible in carefully selected young women with endometrial cancer. Recurrence rates were high during long term observation even after pathological complete remissions. Therefore, close follow up is recommended.     

Endometrial adenocarcinoma in pregnancy.

OBJECTIVE: The coexistence of endometrial adenocarcinoma and pregnancy is rare. Most cases are discovered in the first trimester due to irregular bleeding or spontaneous abortion. CASE: A 44-year-old woman, gravida 3, para 2, was admitted due to abnormal vaginal bleeding. After complete history, physical examination, and laboratory evaluation, she was diagnosed with spontaneous abortion and underwent a suction curettage. Pathological examination of the tissue included chorionic villi and an area of atypical hyperplasia and endometrial cancer. CONCLUSION: Recent association between first-trimester spontaneous abortions and subsequent endometrial cancer makes these rare cases of concurrent endometrial cancer and first trimester of pregnancy attractive in that they may disclose insights into the pathophysiology of hormone-dependent cancers.     

Endometrial adenocarcinoma and the Stein-Leventhal syndrome

Six cases of adenocarcinoma of the endometrium associated with the Stein-Leventhal syndrome are presented. The average age of the patients was 27.8 years. All patients were treated surgically; 2 had preoperative intracavitary irradiation, and 1 had postoperative intravaginal cesium-137 application. At follow-up, ranging from 1 to 15 years, all patients are alive and free of disease. Almost 90% of endometrial adenocarcinoma in association with the Stein-Leventhal syndrome is well differentiated, and appropriate treatment is associated with a good prognosis. Conservative therapy carries the risk of progression of the cancer to more advanced stages and has very little to offer for future fertility. It is suggested that these patients be treated as are any other patients with endometrial cancer.     

Endometrial adenocarcinoma histologic subtypes: Clinical and pathologic profile

All cases of endometrial adenocarcinoma treated at the Geisinger Medical Center from January 1970 to June 1980 were retrospectively reviewed in an attempt to elucidate the clinical and pathologic profiles of the various histologic subtypes. Complete clinical and pathologic data was available in 418 cases of stage I endometrial adenocarcinoma. The frequency of the histologic subtypes were adenocarcinoma 66%, adenoacanthoma 16%, adenosquamous 5%, papillary 8%, clear cell 3%, and secretory 2%. Absolute 5-year survival was adenocarcinoma 88%, adenoacanthoma 91%, adenosquamous 62%, papillary 63% (P less than 0.01), clear cell 43% (P less than 0.001), and secretory 89%. When comparing the clinical and pathologic profile of the various histologic subtypes, adenosquamous (52%, P less than 0.001) and clear cell (43%, P less than 0.05) were associated with the highest percentage of grade 3 differentiation. Adenosquamous (38%, P less than 0.05) and clear cell (36%) also had the highest percentage of deep myometrial invasion. Papillary subtype (46%, P less than 0.05) was associated with the highest percentage of nulliparity. There was no difference among the subtypes when comparing menopausal status, exogenous estrogen, obesity, hypertension, diabetes, or uterine size. In summary, (1) adenocarcinoma and adenoacanthoma are the most frequent subtypes; (2) adenosquamous, papillary, and clear cell have decreased 5-year survival; (3) the decreased 5-year survival in adenosquamous and clear cell subtypes appears to be associated with increased grade 3 differentiation and deep myometrial invasion while the poor prognosis associated with papillary subtype was not related to grade or myometrial invasion.     

Endometrial carcinoma in young women

Two hundred and fifty-four patients with endometrial carcinoma were diagnosed and treated from Feb. 1956 to Apr. 1987. Of these, 35 patients were below the age of 40 years at the time of diagnosis. These patients were analyzed and compared with those aged above 40. The main clinical manifestations were primary sterility and irregular menstruation. An endometrial carcinoma should be suspected in young women with menstruation disorder, sterility and follicular cyst of ovary refractory to treatment. The highly differentiated endometrial carcinoma in young women was easily confused with adenomatous hyperplasia and should be diagnosed with caution. In young patients with stage I well-differentiated disease desirous of childbirth, treatment by large dose of progestogens without hysterectomy may be the method of choice. Estimation of estrogen and progesterone receptors was very helpful in selecting therapeutic modalities and predicting prognosis. The difference of 5-year survival rates between these two groups of patients were not statistically significant.     

Hysteroscopy in the evaluation and treatment of mucinous adenocarcinoma

BACKGROUND: Hysteroscopy to evaluate abnormal uterine bleeding is gaining popularity. The standard methods of evaluation, endocervical curettage, and endometrial biopsy frequently diagnose adenocarcinoma without determining location. Because the treatments of endometrial and endocervical cancers are different, knowing the neoplastic origin is desirable. CASES: Two postmenopausal women were referred for abnormal uterine bleeding. Endometrial biopsies were consistent with mucinous adenocarcinoma without distinction between cervical and endometrial sites. Endocervical curettages were inconclusive. Both patients underwent hysteroscopy at the time of exploratory laparotomy, which revealed the location of the adenocarcinomas, one in the endocervix and one in the uterine fundus. CONCLUSION: The location of adenocarcinoma may be further clarified by the use of intraoperative hysteroscopy, which can aid in determining surgical treatment.     

Endometrial adenocarcinoma: clinical outcome in 881 patients and analysis of 146 patients whose deaths were due to endometrial cancer

Throughout 1970-1975, 881 patients were treated at Departments I and II of Obstetrics and Gynecology, Helsinki University Central Hospital. They were treated mainly by using surgery and/or radiotherapy combined with adjuvant progestin therapy. The over-all uncorrected 5-year survival rate was 72.2% and corrected rate was 82.1%. In 146 out of 245 cases death was due to endometrial cancer, and this group was analyzed separately.     

Endometrial adenocarcinoma: in estrogen, oral contraceptive and nonhormone users.

Forty-four patients younger than age 50 were treated for endometrial adenocarcinoma between July 1966 and June 1976. Nine of these patients had consumed oral contraceptives, 14 had consumed estrogens, and 19 patients had no history of hormonal usage. The results of this study show no differences comparing the ages, presenting symptoms, stages of the disease, and any relation of this disease to metabolic abnormalities.     

Endometrial adenocarcinoma: a primer for the generalist.

Endometrial cancer is the most common gynecologic malignancy in the United States. The mean and median age of women with endometrial adenocarcinoma is 61 years. Most endometrial cancers are type I estrogen-dependent endometrioid adenocarcinomas. Most women with endometrial adenocarcinoma have stage I disease. Patients with stage I disease endometrial adenocarcinoma can be treated with a simple hysterectomy, bilateral salpingo-oophorectomy, peritoneal lavage, and periaortic node dissection in selected cases. The probability of survival according to international statistics is as follows: stage IA, 91%; stage IB, 88%; stage IC, 81%; stage IIA, 77%; stage IIB, 67%; stage IIA, 60%; stage IIIB, 41%; stage IIC, 32%; stage IVA, 20%; stage IVB, 5%.     

Endometrial carcinoma in a young woman

Summary We present an unusual case of endometrial carcinoma which developed in a 22-year-old woman shortly after pregnancy.     

Endometrial adenocarcinoma and the polycystic ovary syndrome.

While endometrial adenocarcinoma is the second most common female genital malignancy, only four per cent of the cases occur in women less than 40 years of age. The relative rarity of this disease in young women requires that we be especially attuned to those who are at high risk. This paper presents two case reports of women with polycystic ovarian disease who developed endometrial adenocarcinoma at 24 years of age. The pathophysiology ovarian disease and its relationship to the development of endometrial adenocarcinoma are discussed.     

Adenosis and adenocarcinoma of the vagina in young women: A review: Adenosis and adenocarcinoma

Prior to 1971, adenosis and primary adenocarcinoma of the vagina were unusual entities. Since then, a marked increase in both processes has occurred, felt to be related to maternal ingestion of Diethylstibestrol (DES) and other estrogenic compounds during the first trimester, with subsequent abnormalities in female off-spring. To date, there are over 170 cases of adenocarcinoma reported, and there may be as many as one million patients with adenosis. Treatment of benign adenosis is somewhat of a controversy but adenocarcinoma is treated with surgery, radiation or a combination thereof, depending upon the specifics of the patients. Four patients are presented, one treated surgically and three with radiotherapy, all with complete remission over one to two years. It behooves all physicians caring for young women to be aware of these disease processes for the maximum therapeutic benefit to be achieved.     

Endometrial cancer in young, normal-weight women

OBJECTIVE: To determine if young, normal-weight women with endometrial cancer have unique risk factors and clinical characteristics when compared with young, overweight and obese women with endometrial cancer. METHODS: Between 1989 and 2003, 1531 patients were treated for endometrial cancer. 188 (12%) of these women were premenopausal and under the age of 50 at time of diagnosis. The patients were divided into three groups based on body mass index (BMI): normal weight (BMI < 25 kg/m2), overweight (BMI 25-30 kg/m2) and obese (BMI > or = 30 kg/m2). Clinical and pathologic characteristics were compared. RESULTS: Of the 188 young endometrial cancer patients, 47 (25%) were of normal weight, 31 (17%) overweight and 106 (56%) obese. 4% of normal-weight, 12% of overweight and 0% of obese patients met criteria for Lynch syndrome/hereditary non-polyposis colorectal cancer (HNPCC). Irregular menstrual cycles were reported by 30% normal-weight, 32% of overweight and 61% of obese women (P = 0.001). 17% of normal-weight, 7% of overweight and 14% of obese women had a history of infertility (P = 0.723). Nulliparity was noted in 57% of normal-weight, 47% of overweight and 57% of obese patients (P = 0.583). Diabetes was reported in 4% of normal-weight, 13% of overweight and 35% of obese patients (P < 0.001). 28% of normal-weight, 26% of overweight and 14% of obese patients had synchronous primary tumors of the endometrium and ovary. CONCLUSIONS: As expected, a significantly higher proportion of obese and overweight women had diabetes and irregular menstrual cycles. Among the normal-weight women, a high proportion were nulliparous, had a history of infertility, irregular menstrual cycles and synchronous tumors of the endometrium and ovary when compared with the general population. This suggests that hormonal factors, and possibly polycystic ovarian syndrome (PCOS), may contribute to the development of endometrial cancer in young normal-weight women.     

Endometrial adenocarcinoma in women under 25 years of age

Ten cases of endometrial carcinoma in young women aged 15 to 25 years are presented. Seven of these ten patients exhibited the clinical characteristics of Stein-Leventhal syndrome; of these, three had evidence of polycystic ovaries. Nine of the tumors were well-differentiated, adenoacanthomas (six) or adenocarcinomas (three) and limited to the endometrium. In one case, a moderately differentiated adenosquamous carcinoma involved an ovary and the pelvic wall. Treatment consisted of curettage and progestogens in three patients, one of whom later bore two children. The remainder of the women were treated with abdominal hysterectomy and bilateral salpingo-oophorectomy and/or radiation therapy. All patients for whom follow-up data are available are alive and well without evidence of disease. It is concluded that in selected young patients with well-differentiated endometrial carcinoma limited to the endometrium, conservative hormonal therapy and curettage may be adequate treatment and may preserve fertility.