A 38-year-old nulliparous woman with well-differentiated endometrioid adenocarcinoma confined to the endometrium (Stage IA, Grade 1, POLE wild-type, no LVSI, no myometrial invasion) wishes to preserve fertility. What is the standard fertility-sparing treatment?

• A Radical hysterectomy is mandatory regardless of fertility wishes
• B Endometrial ablation as definitive treatment
• C LNG-IUS insertion without systemic progestogens
• D Continuous high-dose progestogen therapy (megestrol acetate or MPA) with hysteroscopic surveillance ✓

Explanation

For young women with Grade 1 endometrioid endometrial carcinoma apparently confined to the endometrium (no myometrial invasion on MRI), fertility-sparing treatment with continuous high-dose progestogens (megestrol acetate 160 mg/day or medroxyprogesterone acetate 500–1000 mg/day) achieves complete regression in approximately 70–80% of cases. Hysteroscopic surveillance every 3–6 months is mandatory. After childbearing is complete, definitive hysterectomy is recommended. Endometrial ablation destroys tissue needed for histological monitoring.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.