Publication:

Challenges in the management of endometrial cancer and endometrial hyperplasia with atypia in sub-fertile patient: an emerging medical issue-our experience in a tertiary care centre

Background The cases of endometrial hyperplasia with atypia/endometrial carcinoma with age below 40 years are rising and many are nulliparous at diagnosis. The purpose of the study was to study the oncological and obstetric outcome among young women with above mentioned endometrial pathology treated with fertility preserving approach.

Methods The retrospective cohort approach included 17 patients who visited Bhagwan Mahaveer Jain Hospital from January 2016 to January 2022 with a diagnosis of endometrial hyperplasia with atypia/endometrial carcinoma who met national comprehensive cancer network criteria. The records of all the patients included in the study have been reviewed retrospectively.

Results In our study 13/17 (76.47%) patients showed complete response to hormonal treatment. Conception rates are low (23.07%) even after reversal of the malignancy. Thirteen of 17 patients had associated polycystic ovarian syndrome. Three out of 17 (17.64%) had progressive disease, 5/13 (38.46%) cases had disease recurrence after initial remission out of which 3 had rechallenge with progestins with remission again.

Conclusions Levonorgestrol intra uterine system along with oral progestins is an effective combination as device might be useful in optimising the dose of oral progestins without the need for further escalation of dosage. Levonorgestrol intra uterine device or low dose oral progestins alone should be continued in responders not opting for conception as maintenance hormonal therapy. Hysterectomy should be advised if hormonal treatment fails, and also after completion of childbearing. Myometrial invasion may not be absolute contraindication for fertility sparing treatment. Molecular profiling of endometrial biopsy might help in better prognostication and treatment strategy.