title: Fertility-sparing management of endometrial adenocarcinoma.
abstract: Approximately 15% of patients with endometrial cancer are premenopausal. Previous studies largely support the conservative treatment of endometrial cancer in women desiring future fertility. From these studies, 75% to 80% of patients demonstrate a complete response to progestin therapy and the average recurrence rate is 30% to 35%. Conservative therapy should be reserved for women with International Federation of Gynecology and Obstetrics grade I tumors. Before conservative management, patients should be informed of the elevated risk (11%-29%) of concurrent ovarian cancer in cases of premenopausal endometrial cancer, and screening and ongoing surveillance during the treatment period is mandatory. A suggestion of myometrial invasion or metastatic disease is a contraindication to conservative management. Individuals meeting criteria for Lynch syndrome testing should be referred to genetic counseling. Fertility treatment should be individualized, and close surveillance is required during treatment. Staging hysterectomy is recommended after the completion of the childbearing period.
  
  
  BACKGROUND
  Obstetricians & Gynecologists, Family Physicians Learning Objectives: After participating in this activity, physicians should be better able to select appropriate candidates with endometrial cancer for fertility-sparing treatment. Educate patients with endometrial cancer regarding the risks and benefits of standard of care therapy and conservative therapy and screen appropriate patients for Lynch syndrome.
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, USA.
authors.forename: Jessie
authors.initials: J
authors.lastname: Dorais
authors.forename: Mark
authors.initials: M
authors.lastname: Dodson
authors.forename: Jacob
authors.initials: J
authors.lastname: Calvert
authors.forename: Benjamin
authors.initials: B
authors.lastname: Mize
authors.forename: Jennifer Mitchell
authors.initials: JM
authors.lastname: Travarelli
authors.forename: Kory
authors.initials: K
authors.lastname: Jasperson
authors.forename: Charles Matthew
authors.initials: CM
authors.lastname: Peterson
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Soisson
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D016889:Endometrial Neoplasms / Q000473:pathology / Q000628:therapy*; D005260:Female; D059247:Fertility Preservation; D006801:Humans; D017697:Premenopause; D012307:Risk Factors