A 38-year-old nulliparous woman with Stage IA grade 1 endometrioid endometrial carcinoma confined to the endometrium (no myometrial invasion) strongly desires to preserve fertility. Hormonal conservative management is offered. The MOST appropriate regimen and monitoring interval is:
- A LNG-IUS 52 mg + oral medroxyprogesterone acetate 500 mg/day + repeat hysteroscopy + biopsy at 3 months ✓
- B Combined OCP + hysteroscopy every 12 months
- C GnRH agonist monthly for 6 months then reassess with MRI
- D Oral norethisterone 5 mg twice daily with annual biopsy
Correct answer: A. LNG-IUS 52 mg + oral medroxyprogesterone acetate 500 mg/day + repeat hysteroscopy + biopsy at 3 months
Explanation
Conservative (fertility-sparing) management of Stage IA grade 1 endometrioid carcinoma with no myometrial invasion uses high-dose progestogen therapy: oral medroxyprogesterone acetate (MPA) 500 mg/day or megestrol acetate 160 mg/day, often combined with LNG-IUS for local progestogen delivery. Response is assessed by hysteroscopy + directed biopsy at 3-monthly intervals. Complete histological response (median 6 months) allows fertility treatment. Women should be counselled that hysterectomy remains definitive treatment and fertility-sparing is not standard oncological care.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.