Endometrial Cancer in Young Women: Insights From a Tunisian Cohort

Introduction Endometrial cancer (EC) is typically diagnosed after menopause but can also occur in women under 40 years. In this younger subgroup, tumors are often low-grade and confined to the uterus, yielding favorable outcomes. The management of these patients raises the unique challenge of preserving fertility without compromising oncologic safety. Data from North Africa remain scarce. Methods We retrospectively reviewed medical records of women aged ≤40 years diagnosed with EC in the central region of Tunisia between January 2010 and December 2022. Clinical, pathological, imaging, and treatment data were analyzed. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). Survival outcomes were estimated using the Kaplan-Meier method and compared with the log-rank test. Results Twenty-four patients were included, representing 6.3% of all 381 EC cases diagnosed at our institution between 2010 and 2022. The mean age was 34 years (range: 22-40). A history of infertility was reported in 19 of 24 patients (79.2%), preceding the diagnosis of cancer, and obesity was found in 14 (58.3%). Endometrioid adenocarcinoma was predominant in 16/24 (66.7%), followed by non-endometrioid histologies, including endometrial sarcoma (29.2%) and clear cell carcinoma (4.2%). Eight patients (33.3%) received fertility-sparing treatment consisting of oral high-dose progestins and/or a levonorgestrel-releasing intrauterine device. Adjuvant therapy, including radiotherapy, chemotherapy, or combined chemoradiotherapy, was administered to eight patients (33.3%), with no postoperative hormone therapy. Conclusion EC in women under 40 years is uncommon but generally associated with favorable outcomes. This study provides the first dedicated data on young women with EC from central Tunisia. Conventional pathological factors remain the main prognostic determinants in this resource-limited setting. Prospective studies incorporating molecular profiling are needed to refine risk stratification and guide tailored management strategies.