A 45-year-old woman with Grade 1 endometrioid endometrial carcinoma Stage IA (confined to endometrium, no myometrial invasion) desires future fertility. She has no other medical contraindications. After thorough counselling, which is the most appropriate fertility-sparing approach?
- A Hysteroscopic resection of tumour followed by oral progestins
- B Progestin therapy (medroxyprogesterone acetate 500 mg/day or megestrol acetate 160 mg/day) with serial endometrial biopsies every 3–6 months ✓
- C LNG-IUS insertion alone without systemic therapy
- D Observation only with annual endometrial surveillance
Explanation
Fertility-sparing management of Stage IA Grade 1 endometrioid endometrial carcinoma is acceptable in highly selected young women who strongly desire future fertility, after confirming no myometrial invasion on MRI and absence of synchronous ovarian malignancy. The standard protocol is high-dose oral progestins (MPA 500 mg/day or megestrol acetate 160 mg/day), with mandatory serial endometrial biopsies every 3–6 months to confirm complete pathological response. A response rate of 70–80% is achieved; patients must complete childbearing and proceed to hysterectomy. LNG-IUS alone has lower complete response rates and is considered experimental.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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