What are the conservative treatments for endometrial cancer?

Endometrial cancer is a common cancer. In fact, many female friends do not pay attention to it. Because its symptoms are similar to many gynecological diseases, it is often discovered very late. The more common methods for conservative treatment of endometrial cancer are drug therapy, conservative surgical treatment, etc., including the use of intrauterine contraceptive rings containing progesterone for treatment.

1. Drug treatment: Progesterone has been used to treat endometrial cancer for nearly 50 years and is the first-line drug for conservative treatment of endometrial cancer. Medroxyprogesterone acetate and medroxyprogesterone acetate are commonly used clinically. Progesterone should be administered for at least 12 weeks. Magnetic resonance imaging and curettage or hysteroscopy should be performed after medical treatment. If pathological examination shows no cancer and endometrial hyperplasia, it should be diagnosed as clinical complete remission. These patients should continue consolidation therapy for 3-9 months. If there is no recurrence, you can try to get pregnant after stopping the medication. In addition, since long-term and excessive use of progesterone may downregulate progesterone receptors, while tamoxifen may upregulate progesterone receptors, some scholars have combined progesterone with tamoxifen to treat endometrial cancer. The complete remission rate with progesterone therapy is approximately 50%.

2. Conservative surgical treatment: If the lesion is relatively limited, especially if the lesion is polyp-like, hysteroscopy can be used to remove the cancer and the surrounding endometrium and part of the muscle layer. Oral progesterone is taken for 6 months after surgery, and pregnancy can be attempted after hormone therapy is completed. It should be noted that if more uterine tissue is removed, the morphology of the uterine cavity will change severely, which will affect postoperative pregnancy.

3. Other treatment methods: In recent years, some researchers have also proposed conservative treatment with an intrauterine contraceptive ring containing progestin (Manyuele). Dieffenbachia can locally inhibit tumor cells. After Mirena implantation, endometrial biopsy should be performed every 4-6 months. If there is no disease progression, the total duration of use is 1 year.

Patients who are willing to give birth should become pregnant as early as possible. Young women with endometrial cancer often have obesity, polycystic ovary syndrome, and other medical conditions that may cause ovulatory dysfunction, combined with endometrial factors that may lead to infertility. It is recommended that such patients be treated as soon as possible after complete remission or undergo assisted reproductive technology to assist pregnancy. Those with no history of infertility can try to conceive naturally for 3 months. If they have not gotten pregnant for more than 3 months, assisted reproductive technology is also recommended to help get pregnant as soon as possible. Existing studies have reported pregnancy rates as high as 35% in young patients with endometrial cancer after conservative treatment. However, if pregnancy is not achieved during ovulation induction, the disease may recur and the endometrium should be checked every 3-6 months.

The patients who retained their uterus were followed closely for 2 years. Hysteroscopy was performed every 3 months during the first year and every 6 months during the second year. Those who need to have another child after a natural birth will undergo a curettage 6 weeks after delivery. If there is no reproductive desire after a natural birth, standard endometrial cancer staging surgery should be performed after delivery. Patients who desire reproduction after cesarean delivery require intraoperative exploration, including careful exploration of the ovaries, peritoneal lavage fluid cytology, pelvic and para-aortic lymph node sampling, and biopsy of any suspicious lesions.