Endometrial carcinoma under the age of 40: reappraisal for oophorectomy in stage I disease

Objective: To reappraise the rationale of castration and the necessity of retroperitoneal lymph node biopsy in patients with endometrial carcinoma under the age of 40 years.Methods: A retrospective review of 30 patients under the age of 40 among 815 patients who had primary endometrial cancer treatment was carried out. The review consisted of clinical data, surgical pathology, and survival rates, as well as a comparative study of the literature.Results: The average age was 35.1 years. Three-quarters of the patients (76.6%) had stage I disease. Almost half of them had risk factors for endometrial carcinoma. The pathologic type was adenocarcinoma in 83% and grade 1 in 57%. Among 23 patients with stage I disease, 7 (30.4%) had no residual disease. Even with 16 patients found to have residual disease, 10 had it confined to the endometrium. Ovarian malignancy was only seen in 2 instances. Five demonstrated corpus luteum. Only 3 (13%) had lymph node metastasis and all in advanced disease. Six (20%) of these patients had delayed treatment more than 6 months. The follow-up was 5 months to 19 years. All are living and free of disease in stage I and stage II. Both patients with stage III disease died.Conclusions: In view of low risks in these young women with stage I disease, a thorough surgical staging including lymph node resection is desirable and hysterectomy with ovarian preservation is the treatment of choice. Oophorectomy might be considered in patients with cancer of the ovaries or in advanced stages of disease.