For nulliparous women wishing to preserve the uterus
MRI, CT and D&C at week 0
If presumptive FIGO stage Ia& grade 1 endometrioid adenocarcinoma
- No myometrial invasion on T2-weighted pelvic MRI
- No swelling of pelvic and paraaortic lymph nodes on CT scan
- No space occupying lesion on CT scan
- Grade 1 endometrioid adenocarcinoma on HE-stained slides
→ Start MPA* at 600 mg/day
Otherwise
→ Surgical treatment including hysterectomy
D&C at 4, 8 and 12 weeks
If worse histology than before
→ Surgical treatment including hysterectomy
Otherwise
→ Continue MPA at 600 mg/day
D&C at 16 weeks
If any residual carcinomatous focus
→ Surgical treatment including hysterectomy
Otherwise
→ Continue MPA at 200-400 mg/day for another 4 months
then MPA at 10 mg/day until expecting pregnancy
*MPA-medroxyprogesterone acetate |
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