Insulin resistance as a risk factor for endometrial cancer – a case report of fertility-sparing treatment of early-stage endometrial cancer

Abstract

Introduction Endometrial cancer is the most common gynecologic malignancy, and up to a quarter of cases are diagnosed in patients under the age of 45. Important risk factors that create a hyperestrogenic environment are obesity, polycystic ovary syndrome, insulin resistance, and type 2 diabetes mellitus. The standard treatment is classic hysterectomy with bilateral salpingo-oophorectomy; however, this treatment leads to loss of fertility, which poses an issue for younger patients who have not completed childbearing. Therefore, in certain cases, hormonal therapy could be used for early-stage endometrial adenocarcinoma to preserve fertility.

Case outline A 32-year-old female patient with insulin resistance presented with an ultrasonographic finding of an endometrial polyp, and after hysteroscopy and thorough evaluation, a well-differentiated adenocarcinoma of the endometrium (G1), FIGO stage IA, was verified. A conservative treatment was carried out with a levonorgestrel intrauterine device and a gonadotropin-releasing hormone (GnRH) analog for six months. After six months of therapy, there were no signs of malignant cells, and she conceived naturally. Eventually, the patient delivered a healthy baby.

Conclusion Insulin resistance is a potentially modifiable risk factor and thus important in cases of fertility preservation treatment. Management could reduce cancer risk and improve reproductive outcomes. Further studies are needed to better understand the impact of insulin resistance treatment on the success of fertility- sparing management and the rate of recurrence.

Keywords: endometrial cancer; oncofertility; fertility-sparing treatment of endometrial cancer; insulin resistance