A 38-year-old nulliparous woman with Grade 1 endometrial adenocarcinoma confined to the endometrium without myometrial invasion or cervical involvement requests fertility-sparing treatment. The most appropriate management is:

• A Radical hysterectomy with bilateral salpingo-oophorectomy
• B External beam radiotherapy to the pelvis
• C Laparoscopic hysterectomy deferred until after first delivery
• D High-dose progestogen therapy (megestrol acetate or LNG-IUS) with hysteroscopic surveillance ✓

Explanation

Fertility-sparing treatment with progestogens (oral megestrol acetate 160–320 mg/day or LNG-IUS) is a validated option for young women with Grade 1 endometrioid adenocarcinoma limited to the endometrium (Stage IA, no myometrial invasion) who strongly desire fertility preservation. Response rates of 50–75% are reported, with subsequent pregnancy rates of 35–40% after complete response. Hysteroscopic surveillance biopsies every 3–6 months are mandatory. Definitive hysterectomy should follow once childbearing is complete.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.