Question 52 (part 2) · LEK · Endometrial cancer
A 36-year-old female is diagnosed with hyperplasia with atypia after endocervical curettage. The patient has never been pregnant, but would like to in the future. What is the proper course of action in her case if we take into account the recommendations of the Polish Society of Gynaecologists and Obstetricians and oncofertility principles?
- A. body of uterus amputation without oophorectomy due to the 25% risk of endometrial cancer.
- B. simple hysterectomy without oophorectomy due to the 25% risk of endometrial cancer.
- C. endometrium resection and referring the patient for IVF.
- D. commencing the treatment with combined oral contraceptive pills or GnRH analogues for 12 months and a control uterine curettage.
- E. the use of a hormonal intrauterine device or progestogens for 6 months and a uterine curettage or a pipelle biopsy after 6 months to monitor the regression of the lesions.
Hint
Fertility-sparing management of atypical hyperplasia relies on progestogens with histological follow-up rather than surgery.
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