2 Update_DOMENICI.qxp_-

Endometrial cancer (EC) represents one of the most invasive and frequent neoplasm of the female genital tract (5% of all female tumours), with an estimated 46,470 diagnosed cases and 8,120 deaths in 2011 in the United States with 25.4 cases on 100.000 women per year in Italy (1). Endometrial adenocarcinoma commonly occurs in postmenopausal women and its incidence increases dramatically between the ages of 45 and 65 (2). Risk factors for endometrial carcinoma include long-term estrogen overstimulation, obesity, diabetes, metabolic syndrome, polycystic ovary syndrome, estrogen-producing tumors, a history of nulliparity or infertility, early menarche, late menopause (3). Abnormal uterine bleeding (AUB) is the most common symptom related to EC (over 90% of patients). Thanks to this usual presentation, 75% of ECs are diagnosed at an early stage. Atypical endometrial hyperplasia (AEH) is felt to be a precursor of lesions with around 29-43% of risk-progression to EC (4, 5). In addition, AEH is associated with a coexisting EC in approximately 20% of patients (6). Although EC is mainly identified in postmenopausal women, around 14% of cases might be present in pre-menopausal women, including 4% diagnosed in women equal or under 40 years of age, as a consequence of a hyperestrogenic state, who wish to preserve their fertility. Likewise, conservative management of endometrial carcinoma has become a necessity. Fertility preservation treatment might be considered as a therapeutic option in carefully selected women with well-differentiated EC without myometrial invasion or adnexal disease. A satisfactory assessment of myometrial invasion can be achieved with imaging (ultrasound, MRI, CT) or histology (hysteroscopy-guided deep biopsy). The principal issue regarding conservative management of EC is disease progression after initial response to meUpdate on fertility-sparing treatment in primary and recurrent endometrial cancer