While surgery is the standard of care for endometrial cancer, a unique clinical challenge arises when a premenopausal woman is diagnosed with a Grade 1, Stage IA endometrioid adenocarcinoma and wishes to preserve her fertility.
In these highly specific cases, Hormonal Therapy is utilized as a primary treatment rather than an adjuvant one. The most common approach involves high-dose progestins, such as Megestrol Acetate or the insertion of a Levonorgestrel-releasing Intrauterine System (LNG-IUS).
Progestins work by binding to progesterone receptors in the endometrial tissue, which counteracts the proliferative effects of estrogen, ideally inducing a "reversal" of the cancerous cells back into a normal or hyperplastic state. This treatment requires rigorous monitoring via serial endometrial biopsies every three months. Once a "complete response" (no cancer detected) is achieved, the patient is often encouraged to pursue pregnancy immediately, as the risk of recurrence remains high. After childbearing is complete, a definitive hysterectomy is usually recommended to prevent the return of the malignancy.