Endometrial cancer

Endometrial cancer

Endometrial carcinoma associated with pregnancy is uncommon. Only 27 cases were reported up to 1999. In 13 of these cases the diagnosis of endometrial cancer was established during the first trimester or early in the second, either after abortion, after surgery for adnexal mass, or during evaluation of abnormal uterine bleeding. In 11 cases the diagnosis was established postpartum.

These 27 cases exhibit an atypical epidemiology because they do not present the usual risk factors for endometrial cancer, as endometrial cancer usually affects women who are in their sixth decade of life and who frequently have a history of diabetes, hypertension, and factors which relate to high or unopposed levels of estrogen, such as obesity, infertility, polycystic ovary syndrome, or estrogen-secreting ovarian neoplasms. Furthermore, the existence of an endometrial malignancy before conception likely creates an intrauterine environment that is unfavourable for embryo implantation.

Adenocarcinoma associated with pregnancy is typically endometrioid, focal, well-differentiated and minimal invasive. However, death from this disease has been reported. In 3 other cases, simultaneous ovarian neoplasms were found.

Active treatment of endometrial carcinoma is incompatible with the continuation of pregnancy. However, there is rarely a dilemma regarding the balance of fetal and maternal outcomes as nearly all reported cases in the literature were in association with miscarriage or in the postpartum period.
Standard treatment and staging for endometrial carcinoma is surgical. FIGO introduced a surgical/pathologic scheme that considered the histopathologic findings obtained at exploratory laparotomy, peritoneal cytology, total abdominal hysterectomy, and bilateral salpingo-oophorectomy with pelvic lymph node sampling. These findings are used for determination of the need for postoperative adjuvant radiotherapy or chemotherapy. Although several reports describe the safety and efficacy of laparoscopic techniques for the management of well-differentiated endometrial cancer at low risk for metastatic disease, this minimally invasive approach is still considered investigational and its safety in the peripartum period is unknown.

It is unclear whether pregnancy affects prognosis in endometrial cancer. In general, patients with well-differentiated, superficially invasive endometrial carcinoma have an excellent prognosis, with greater than 95% surviving 5 years. Since this represents the majority of patients with pregnancy-associated endometrial cancer, one would expect generally favourable outcomes.

These rare cases underscore the importance of endometrial sampling for postpartum abnormal uterine bleeding. Along with endometrial pathology, the possibility of gestational trophoblastic neoplasm must also be considered.