A 45-year-old with Grade 1 endometrioid endometrial carcinoma Stage IA who wishes to preserve fertility is considered for conservative management. The required minimum endometrial thickness confirming response to progestogen therapy on repeat biopsy is:

• A Complete histological regression (no evidence of carcinoma on repeat biopsy at 3–6 months) ✓
• B Endometrial thickness reduction to <5 mm on ultrasound
• C 50% reduction in tumour volume on MRI
• D Normalisation of CA-125 and CEA levels

Explanation

Conservative (fertility-sparing) management of early endometrial carcinoma (Grade 1, Stage IA with no myometrial invasion on MRI) uses high-dose progestogens (medroxyprogesterone acetate 250–500 mg/day or megestrol acetate, or LNG-IUS). Response is assessed by repeat hysteroscopy-guided endometrial biopsy at 3–6 months; complete histological regression (absence of carcinoma on biopsy) is the required endpoint before attempting conception. Partial response or stable disease necessitates continuation of therapy or surgical management. Ultrasound thickness, MRI volume, and tumour markers are not reliable surrogate endpoints.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.