子宫内膜癌及治疗方案
The most common gynecologic cancer is endometrial cancer,which accounts for an estimated 69% of all cancers in women (1,2).That said, many of the women who are diagnosed with endometrial cancer are past reproductive age. No more than 5% of endometrial cancers occur in women who are less than 40 years of age.In this cohort of women, these neoplasms tended to be well-differentiated with not only an indolent biology but also confinement to the uterus at diagnosis. " A surfeit of estrogen,such the levels seen in obesity and an ovulation, is the chief risk factor for the occurrence of low-grade endometrial neoplasms.Moreover,an estimated 25% of young women who do develop endometrial cancer will also have polycystic ovary syndrome(PCOS)(1). This alleged “low risk" cancer has an overall 5-year survival rate of over 90%.
最常见的妇科癌症是子宫内膜癌，在女性所有癌症中占比69%(1，2)。即便如此，确诊子宫内膜癌的女性大多已过生育年龄。年龄在40岁以下的子宫内膜癌患者占比不超于5%。在这组女性患者中，诊断时，这些肿瘤往往分化良好，不仅具有惰性生物学特征，并且紧贴于子宫。过量的雌二醇激素，如同肥胖人士和排卵期女性的雌二醇水平一般，是出现低级别子宫内膜瘤的主要危险因素。 此外，约25%的患有子宫内膜癌的年轻女性还存在多囊卵巢综合症的情况(1)。这里所指的“低风险”癌症的五年生存率整体超过90%。
Standard Treatment Approach 标准治疗方案
For endometrial cancer, the standard treatment approach is hysterectomy and bilateral salpingo-oophorectomy(3).For women with high-risk histology or advanced disease, adjuvant postoperative radiation therapy or chemotherapy may be appropriate. Because most women with endometrial cancer are past their reproductive years,fertility-sparing surgery is not commonly considered.
子宫内膜癌的标准治疗方案是子宫切除术和双侧输卵管及卵巢切除术(3)。对于患有高风险组织或晚期疾病的人来说，术后辅助性放射治疗和化疗也许是恰当的选择，因为绝大多数患有子宫内膜癌的女性均已过生育年龄，通常不会考虑生育力保存术。
Fertility-Sparing Approach生育力保存的治疗方法
In certain younger women who not only have low-grade endometrial carcinoma but also desire fertility preservation,fertility-sparing approaches may be appropriate. These treatment approaches usually use medical treatment with progestin therapy. Such an approach is recommended only for young women who have non-invasive(stage IA), hormone-sensitive lesions (typically Grade I histology) with a desire for future fertility and an otherwise reasonable likelihood for conception after therapy(4,5,6).
对于一些有低等级子宫内膜癌但又希望保留生育能力的年轻女性来说，保存生育力的治疗方案可能更适合，这些治疗方法往往会借助孕激素疗法进行药物治疗。这种治疗方法仅推荐用于具有非侵入性，激素敏感病变，希望未来生育且治疗后有合理受孕可能性的年轻女性 (4，5，6)。
References 数据参考：
1. DiSaia PJ, , Adenocarcinoma of the uterus. In: DiSaia PJ, Creasman WT(Eds) . Clinical gynecologic oncology. 5th edition. St. Louis:Mosby.1997; 134-68
2. American Cancer Society, Cancer facts and figures. 2002. Available at:http: //www.cancer.org:p. (Last accessed:May, 13,2007).
3. Scholten AN, van Putten WL, Beerman H, et al. Postoperativeradiotherapy for Stage 1 endometrial carcinoma:long-term outcomeof the randomized PORTEC trial with central pathology review. Int JRadiat Oncol Biol Phys. 2005; 63 (3) : 834-8.
4. Benshushan A. Endometrial adenocarcinoma in young patients:evaluation and fertility-preserving treatment. Eur J Obstet GynecolReprod Biol. 2004; 117 (2) : 132-7
5. Kaku T,Yoshikawa H,Tsuda H,et al.Conservative therapy foradenocarcinoma and atypical endometrial hyperplasia of theendometrium in young women: central pathologic review andtreatment outcome. Cancer Lett. 2001; 167 (1) : 39-48.
6. Pinto AB, Gopal M, Herzog TJ,et al.Successful in vitro fertilizationpregnancy after conservative management of endometrial cancer.Fertil Steril. 2001; 76 (4) : 826-9.
