Saving the Uterus in Endometrial Cancer

43-year-old woman who has put off motherhood in favor of a career now wants to bear a child. She’s been in relatively good health, but when she visits her local gynecologist for an examination, she is stunned to hear the words “endometrial cancer” and then “hysterectomy.”

Until very recently, hysterectomy would have been automatic for a women with such a diagnosis, points out Fredrick J. Montz, M.D., director of Hopkins’ Division of Gynecologic Oncology. “Endometrial cancer meant your uterus needed to come out, your ovaries needed to come out, and there was no option. That really closed the door for a lot of women,” Montz adds, “so we started looking at ways in which you could manage patients with early-stage, low-grade endometrial cancer and preserve the uterus.” Today Hopkins is one of a handful of medical centers developing alternative treatments for the disease.

Key to the new approach is the hormone progesterone, which prepares the endometrium for pregnancy. Progesterone, says Montz, can slow, stop and, in some cases, even reverse the course of endometrial cancer, which afflicts some 34,000 Americans each year. He cites a study in Cancer (Jan. 15, 1997) reporting that endometrial carcinoma can be treated successfully with progestins alone. Another (Obstetrics and Gynecology; September 1997) showed that progestin treatment for carcinoma and its precursor, atypical hyperplasia, appears to be a safe alternative to hysterectomy in women under age 40. Both studies, however, cite the side effects of progestin—acne, bloating, leg cramps and weight gain—and note that the disease may progress during treatment.

To counter those systemic effects, Montz has taken the therapy one step further and utilized an intrauterine device impregnated with progesterone. The method delivers more of the hormone dosage directly to the endometrium and less to the body. And to minimize the risk of tumor growth, Montz cautiously screens progestin candidates and requires biopsy and imaging follow-up every three months.

—Gary Logan