Adenocarcinoma of the endometrium in women aged forty and younger

Twenty-two women aged 40 years and younger have been diagnosed as endometrial carcinoma at Barnes Hospital from 1930 to 1967. Seven of these were rediagnosed as hyperplasia on review of the histologic sections; the remaining 15 had endometrial changes consistent with adenocarcinoma. All of the patients rediagnosed as adenocarcinoma were living and well without evidence of disease when last examined. The authors conclude that endometrial carcinoma has a better prognosis in the young woman than in the older patient. The authors recommend the following: Patients with lesions in which uncertainty exists between adenomatous hyperplasia and well-differentiated adenocarcinoma should be treated with progestational agents. Hysterectomy should be performed only for lesions which do not respond to hormonal therapy. Young patients with well-differentiated adenocarcinoma should be treated conservatively with progestational agents and repeat curettage; if the lesion does not regress and there is no evidence of spread of the tumor beyond the endometrium, hysterectomy is the treatment of choice. Castration should be avoided unless it is necessary for cure. Poorly differentiated adenocarcinomas, sarcomas and adenocarcinomas of the endocervix should be separated from the group of women with well-differentiated lesions and treated aggressively.