Endometrial cancer in women younger than 50 years: Clinicopathological features, treatment patterns and outcomes in a Moroccan cohort

Background: Endometrial cancer is the most frequent pelvic malignancy and occurs mainly in post‑menopausal women. Only a small proportion of cases are diagnosed in women under the age of 50, and data describing this population in North Africa are scarce. This study aimed to characterize the clinicopathological features, treatment modalities and outcomes of endometrial cancer in Moroccan women younger than 50 years.

Methods: We performed a retrospective study of 40 women aged 33–50 years treated for endometrial cancer between 2018 and 2022 at the Hassan II University Hospital, Fees. Epidemiological, clinical and histopathological variables were extracted from standardized, anonymized forms. All patients underwent surgery; adjuvant treatments included external beam radiotherapy, high‑dose‑rate (HDR) vaginal brachytherapy and chemotherapy. Data were analyzed using SPSS v22.0; quantitative variables are summarized as means ± standard deviations and qualitative variables as numbers and percentages.

Results: The mean age at diagnosis was 46 years (range 33–50). Forty‑five per cent of patients were pre‑menopausal and 52 % were nulliparous. Hypertension and diabetes were each present in one patient. Endometrioid adenocarcinoma accounted for 71.6 % of cases, whereas serous, clear‑cell, undifferentiated, mixed tumors and carcinosarcomas comprised 35.1 % of tumors. Most endometrioid tumors were grade 1 or 2. Over half of women presented with stage I disease (20 % stage IA, 37.5 % stage IB), while 25 % were stage III and 10 % stage IV. All patients underwent hysterectomy with bilateral sapling‑oophorectomy. In total, 54 % received adjuvant external beam radiotherapy (45–50 Gy) followed by HDR brachytherapy, 30 % received brachytherapy alone and 10 % received palliative chemotherapy. After a median follow‑up of 35 months, 63 % of patients remained disease‑free, 5 % experienced local recurrence, 15 % developed distant recurrence and 7.5 % showed progression despite adjuvant therapy.

Conclusion: Endometrial cancer in Moroccan women younger than 50 years is predominantly endometrioid, low‑grade and early‑stage, mirroring global observations. Outcomes were favorable with multimodal therapy, and no unique clinicopathological features were identified compared with older patients. Nevertheless, the high proportion of nulliparous and pre‑menopausal women underscores the importance of counselling about fertility‑sparing options. For carefully selected patients with grade 1 endometrioid carcinoma limited to the endometrium, conservative management with high‑dose progestins or levonorgestrel‑releasing intrauterine devices may be considered, with definitive surgery advised once childbearing is complete.