Early Stages: Is There a Place for Hysteroscopic Treatment?

Abstract

Endometrial cancer is the most common gynecological malignancy; approximately 20% is diagnosed in premenopausal women and 5% in women up to 40 years old and its incidence is rising among young women, reaching 1% for year. Stated the increasing rate of pregnancy achieved by women in advanced age, thanks to assisted reproductive technologies, endometrial cancer is often diagnosed in patients who have not fulfilled their reproductive plan, highlighting the importance of fertility preservation in this population.

The use of progestins is the most often proposed option as a conservative treatment. Several authors proposed to combine hormonal treatment to conservative hysteroscopic treatment. In our clinical practice, we proposed resectoscopical resection of the endometrial neoplastic lesion, of the myometrium under the lesion, of the endometrium and myometrium surrounding the lesion, performing at last random endometrial–myometrial biopsies of the contralateral uterine walls. If the pathologic analysis confirmed the absence of myometrium invasion, hormone therapy regimen was initiated and prosecuted for 6–9 months.

In women with advanced age and high surgical risk for several comorbidities, diagnosed with EIN or well-differentiated-G1 endometrioid adenocarcinoma, the best regime to propose remains also a complex and controversial area. These patients have been usually selected for radiotherapic treatment, but the radiation dosimetry may be suboptimal if a patient is too heavy or the surface anatomy is too irregular; moreover, studies have shown that external beam radiotherapy was not without toxicities. We proposed in these patients resectoscopic endometrial ablation: this technique, involving underlying myometrium, allows an accurate histological diagnosis and a proper selection of patients who would be submitted to radiotherapy.