Tag Archives: gynecologic malignancy

Fertility-Sparing Options for Endometrial Cancer

Endometrial cancer is the most common gynecologic malignancy in the United States. The incidence is increasing, including in premenopausal women.

According to Joshua Kesterson, M.D., a gynecologic oncologist with Penn State Hershey Obstetrics and Gynecology, “Such women may wish to consider fertility-sparing treatment options and avoid standard treatment, which consists of hysterectomy, bilateral salpingo-oophorectomy and lymph node dissection.”

When considering fertility-sparing treatments, multiple factors must be considered, including the risk of an unstaged cancer, a coexisting cancer, an inherited genetic predisposition to cancer, and the lack of uniformity in medical management of endometrial cancer. When patients move forward with treatment, Kesterson stresses the importance of a thorough pre-treatment assessment, to decrease the chances of an undetected cancer.1

Endometrial Hyperplasia

Excess estrogen can lead to hyperplasia of the endometrium, a precursor to endometrial cancer, as seen here with back-to-back crowding of glands.

“I begin each case with dilation and curettage, as both a diagnostic step to confirm the low-grade nature of the tumor and a potential therapeutic benefit from removing the abnormal cells. I follow with an MRI to identify potential myometrial or cervical invasion or lymph node involvement. If there is evidence of grade 2 cancer or higher or metastatic spread, the patient is not an appropriate candidate for uterine preservation.”

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