Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Jun 5;24(11):9780.
doi: 10.3390/ijms24119780.

Upgrading Treatment and Molecular Diagnosis in Endometrial Cancer-Driving New Tools for Endometrial Preservation?

Miriam Dellino  1 , Marco Cerbone  1 , Antonio Simone Laganà  2 , Amerigo Vitagliano  1 , Antonella Vimercati  1 , Marco Marinaccio  1 , Giorgio Maria Baldini  3 , Antonio Malvasi  1 , Ettore Cicinelli  1 , Gianluca Raffaello Damiani  1 , Gerardo Cazzato  4 , Eliano Cascardi  5   6
Affiliations
Review

Upgrading Treatment and Molecular Diagnosis in Endometrial Cancer-Driving New Tools for Endometrial Preservation?

Miriam Dellino et al. Int J Mol Sci. .

Abstract

One emerging problem for onco-gynecologists is the incidence of premenopausal patients under 40 years of age diagnosed with stage I Endometrial Cancer (EC) who want to preserve their fertility. Our review aims to define a primary risk assessment that can help fertility experts and onco-gynecologists tailor personalized treatment and fertility-preserving strategies for fertile patients wishing to have children. We confirm that risk factors such as myometrial invasion and The International Federation of Gynecology and Obstetrics (FIGO) staging should be integrated into the novel molecular classification provided by The Cancer Genome Atlas (TCGA). We also corroborate the influence of classical risk factors such as obesity, Polycystic ovarian syndrome (PCOS), and diabetes mellitus to assess fertility outcomes. The fertility preservation options are inadequately discussed with women with a diagnosis of gynecological cancer. A multidisciplinary team of gynecologists, oncologists, and fertility specialists could increase patient satisfaction and improve fertility outcomes. The incidence and death rates of endometrial cancer are rising globally. International guidelines recommend radical hysterectomy and bilateral salpingo-oophorectomy as the standard of care for this cancer; however, fertility-sparing alternatives should be tailored to motivated women of reproductive age, establishing an appropriate cost-benefit balance between childbearing desire and cancer risk. New molecular classifications such as that of TCGA provide a robust supplementary risk assessment tool that can tailor the treatment options to the patient's needs, curtail over- and under-treatment, and contribute to the spread of fertility-preserving strategies.

Keywords: endometrial cancer; fertility preservation; molecular characterization; reproductive outcome.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
WHO-proposed algorithm for testing EC pathological specimens. Rearranged and modified from Crosbie et al. [55].
Figure 2
Figure 2
Hyperplasia/endometrial cancer: (A) 3D ultrasound exam; (B,C) Color–Doppler score examination—Courtesy of MD and VP; (D) Hysteroscopic typical pattern for endometrial hyperplasia/endometrial cancer. Courtesy of GRD.
Figure 3
Figure 3
Integrated NCCN and ESGO guidelines flow chart for fertility-sparing management.
See this image and copyright information in PMC

References

    1. Corpus C.U., Vulva U.O.V. Gynecologic Cancer Incidence, United States—2012–2016. Centers for Disease Control and Prevention, US Department of Health and Human Services; Atlanta, GA, USA: 2019.
    1. Dellino M., Cascardi E., Laganà A.S., Di Vagno G., Malvasi A., Zaccaro R., Maggipinto K., Cazzato G., Scacco S., Tinelli R., et al. Lactobacillus crispatus M247 oral administration: Is it really an effective strategy in the management of papillomavirus-infected women? Infect. Agents Cancer. 2022;17:53. doi: 10.1186/s13027-022-00465-9. - DOI - PMC - PubMed
    1. Sung H., Ferlay J., Siegel R.L., Laversanne M., Soerjomataram I., Jemal A., Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J. Clin. 2021;71:209–249. doi: 10.3322/caac.21660. - DOI - PubMed
    1. Viviani S., Dellino M., Ramadan S., Peracchio C., Marcheselli L., Minoia C., Guarini A. Fertility preservation strategies for patients with lymphoma: A real-world practice survey among Fondazione Fertility preservation strategies for patients with lymphoma: A real-world practice survey among Fondazione Italiana Linfomi centerscenters. Tumori J. 2022;108:572–577. doi: 10.1177/03008916211040556. - DOI - PubMed
    1. Zhang S., Gong T.-T., Liu F.-H., Jiang Y.-T., Sun H., Ma X.-X., Zhao Y.-H., Wu Q.-J. Global, Regional, and National Burden of Endometrial Cancer, 1990–2017: Results from the Global Burden of Disease Study, 2017. Front. Oncol. 2019;9:1440. doi: 10.3389/fonc.2019.01440. - DOI - PMC - PubMed

LinkOut - more resources