Endometrial adenocarcinoma in young-aged women: a Turkish population study

Purpose of investigation: The present study aims to investigate the incidence, clinicopathological features, and experience of treatment outcomes of patients with endometrial adenocarcinoma (EC) at ≤ 40 years of age in a gynecologic oncology reference center in Ankara, Turkey. Materials and Methods: This retrospective study included 577 patients with EC, diagnosed and treated between 2007 and 2013. Results: The incidence of EC ≤ 40 years of age was 5.1% (n: 30). The mean age at diagnosis was 35.5 (range: 27-40). Most of the patients with EC were overweight or obese. However, 23% had normal body mass index (BMI). Infertility was seen as a risk factor in 38.4%. The mean duration of postoperative follow-up was 38.3 months with rates of disease persistence and recurrence 14.2% and 28.5%, respectively. Conclusion: The disease is diagnosed usually in its early stage and has a good prognosis. Appropriately selected patients with fertility desire have the opportunity to conceive with conservative management.

Endometrial adenocarcinoma; Gynecological cancer; Young women; Infertility; Obesity.

[1] Crissman J.D., Azoury R.S., Barnes A.E., Schellhas H.F.: “En-dometrial carcinoma in women 40 years of age or younger”. Obstet. Gynecol., 1981, 57, 699.

[2] Gallup D.G., Stock R.J.: “Adenocarcinoma of the endometrium in women 40 years of age or younger”. Obstet. Gynecol., 1984, 64, 417.

[3] Iram S., Musonda P., Ewies A.A.: “Premenopausal bleeding: When should the endometrium be investigated? A retrospective non-comparative study of 3006 women”. Eur. J. Obstet. Gynecol. Reprod. Biol., 2010, 148, 86.

[4] Pellerin G.P., Finan M.A.: “Endometrial cancer in women 45 years of age or younger: a clinicopathological analysis”. Am. J. Obstet. Gynecol., 2005, 193, 1640.

[5] Kaku T., Matsuo K., Tsukamoto N., Shimamoto T., Sugihara K., Tsu-ruchi N., et al.: “Endometrial carcinoma in women aged 40 years or younger: a Japanese experience”. Int. J. Gynecol. Cancer, 1993, 3, 147.

[6] Spencer C.P., Whitehead M.I.: “Endometrial assessment revisited”. Br. J. Obstet. Gynaecol., 1999, 106, 623.

[7] Bayer S.R., DeCherney A.H.: “Clinical manifestations and treatment of dysfunctional uterine bleeding”. JAMA, 1993, 269, 1823.

[8] Creasman W.: “Revised FIGO staging for carcinoma of the endometrium”. Int. J. Gynaecol. Obstet., 2009, 105, 109.

[9] Dizon D.S.: “Treatment options for advanced endometrial carcinoma”. Gynecol. Oncol., 2010, 117, 373.

[10] Gunderson C.C., Fader A.N., Carson K.A., Bristow R.E.: “Onco-logic and reproductive outcomes with progestin therapy in women with endometrial hyperplasia and grade 1 adenocarcinoma: a systematic review”. Gynecol. Oncol., 2012, 125, 477.

[11] Vehid S., Aran S.N., Koksal S., Isiloglu H., Senocak M.: “The preva-lence and the age at the onset of menopause in Turkish women in rural area”. Saudi Med. J., 2006, 27, 1381.

[12] Duijkers I.J., Klipping C.: “Polycystic ovaries, as defined by the 2003 Rotterdam consensus criteria, are found to be very common in young healthy women”. Gynecol. Endocrinol., 2010, 26, 152.

[13] Soliman P.T., Oh J.C., Schmeler K.M., Sun C.C., Slomovitz B.M., Gershenson D.M., et al.: “Risk factors for young premenopausal women with endometrial cancer”. Obstet. Gynecol., 2005, 105, 575.

[14] Koss L.G., Schreiber K., Oberlander S.G., Moussouris H.F., Lesser M.: “Detection of endometrial carcinoma and hyperplasia in asymp-tomatic women”. Obstet. Gynecol., 1984, 64, 1.

[15] Bean S.M., Connolly K., Roberson J., Eltoum I., Chhieng D.C.: “In-cidence and clinical significance of morphologically benign-ap-pearing endometrial cells in patients age 40 years or older: the impact of the 2001 Bethesda System”. Cancer, 2006, 108, 39.

[16] Beal H.N., Stone J., Beckmann M.J., McAsey M.E.: “Endometrial cells identified in cervical cytology in women > or = 40 years of age: criteria for appropriate endometrial evaluation”. Am. J. Obstet. Gynecol., 2007, 196, 568.

[17] Werner H.M., Trovik J., Marcickiewicz J., Tingulstad S., Staff A.C., Engh M.E., et al.: “A discordant histological risk classification in preoperative and operative biopsy in endometrial cancer is reflected in metastatic risk and prognosis”. Eur. J. Cancer, 2013, 49, 625.

[18] Yildiz A., Yetimalar H., Kasap B., Aydin C., Tatar S., Soylu F., et al.: “Preoperative serum CA 125 level in the prediction of the stage of disease in endometrial carcinoma”. Eur. J. Obstet. Gynecol. Reprod. Biol., 2012, 164, 191.

[19] Onat G., Kizilkaya Beji N.: “Effects of infertility on gender differences in marital relationship and quality of life: a case-control study of Turkish couples”. Eur. J. Obstet. Gynecol. Reprod. Biol., 2012, 165, 243.

[20] Dursun P., Erkanli S., Guzel A.B., Gultekin M., Tarhan N.C., Al-tundag O., et al.: “A Turkish Gynecologic Oncology Group study of fertility-sparing treatment for early-stage endometrial cancer”. Int. J. Gynaecol. Obstet., 2012, 119, 270.

[21] Perri T., Korach J., Gotlieb W.H., Beiner M., Meirow D., Friedman E., et al.: “Prolonged conservative treatment of endometrial cancer patients: more than 1 pregnancy can be achieved”. Int. J. Gynecol. Cancer, 2011, 21, 72.