Endometrial cancer is the most common gynecological neoplasm with an increased incidence in the premenopausal population in recent decades. This raises the problem of managing endometrial cancer in fertile women who have not yet achieved pregnancy. In these women, after careful selection, hysterectomy may be postponed in favor of conservative management if specific requirements are met. The latest evidence is focused on early endometrial carcinoma, endometrioid histotype, Grading 1, with no evidence of myometrial infiltration. Few clinical trials have opened this possibility also for women with an endometrial cancer Grading 2 diagnosis. There are still questions about the best medical therapy, dosage, route, and duration of treatment. Oral progestins or levonorgestrel-releasing intrauterine devices appear to be the options associated with the best outcome in terms of complete response and lower recurrence rates. Other options include the use of GnRH analogues, surgical hysteroscopy, or metformin, in a therapeutic approach that takes into account the characteristics of the patient. The pursuit of pregnancy should start as soon as two consecutive endometrial biopsies are obtained 3 months apart from each other; it is recommended to refer the patients to ART centers to maximize the success rate. After having reached the fulfillment of the reproductive desire, surgical radical treatment is still recommended.
子宫内膜癌是最常见的妇科恶性肿瘤，近几十年来在绝经前人群中发病率呈上升趋势。这引发了对于尚未完成生育的育龄期女性子宫内膜癌处理策略的问题。对于经过严格筛选且符合特定条件的患者，可考虑推迟子宫切除术而采取保守治疗方案。最新研究证据主要集中于早期子宫内膜样腺癌、组织学分级为1级且无肌层浸润证据的患者。少数临床试验亦将保守治疗的可能性扩展至诊断为2级子宫内膜癌的女性群体。目前关于最佳药物治疗方案、剂量、给药途径及治疗持续时间仍存在争议。口服孕激素或左炔诺孕酮宫内缓释系统在完全缓解率和降低复发率方面显示出较好的疗效。其他治疗选择包括使用促性腺激素释放激素类似物、宫腔镜手术或二甲双胍，具体方案需综合考虑患者个体特征。当连续两次（间隔3个月）子宫内膜活检结果正常后，应尽快启动妊娠计划；建议将患者转诊至辅助生殖技术中心以提高妊娠成功率。在完成生育意愿后，仍推荐进行根治性手术治疗。
肿瘤(癌症)患者之家