Updates on Conservative Management of Endometrial Cancer

Endometrial cancer is the most common gynecologic cancer in the United States. It is typically diagnosed in postmenopausal women. However, given the increasing incidence of risk factors such as obesity and diabetes in younger women, it is becoming a more prevalent problem in this age group. When endometrial cancer is diagnosed in patients of reproductive age, the standard surgical option of hysterectomy and bilateral salpingo-oophorectomy may not be ideal for women interested in future fertility. Hence, conservative options for select patients should be discussed along with the associated outcomes of each approach. A number of studies have shown that in patients with complex atypical endometrial hyperplasia and grade I endometrial carcinoma, a conservative approach is safe and feasible. The aim of this review is to summarize published evidence of fertility-sparing options such as hormonal therapy, hysteroscopic resection of focal lesions, and the role of intrauterine devices. We will also provide the latest updates on ongoing prospective trials that explore strategies for conservative management in women with medical comorbidities or those interested in fertility preservation.