Endometrial Cancer Diagnosis: Difference between revisions
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Occasionally, cervicovaginal cytology or abnormal vaginal discharge may lead to the diagnosis of endometrial cancer. Pap smears taken within 6 months prior to the diagnosis of endometrial cancers were reported to be abnormal 38% of the time, consistent with adenocarcinoma 21% of the time, and in 13% of cases showed atypical glandular cells. <ref name="pmid26315394">Lai CR, Hsu CY, Hang JF, Li AF (2015) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=26315394 The Diagnostic Value of Routine Papanicolaou Smears for Detecting Endometrial Cancers: An Update.] ''Acta Cytol'' 59 (4):315-8. [http://dx.doi.org/10.1159/000438975 DOI:10.1159/000438975] PMID: [https://pubmed.gov/26315394 26315394]</ref> | Occasionally, cervicovaginal cytology or abnormal vaginal discharge may lead to the diagnosis of endometrial cancer. Pap smears taken within 6 months prior to the diagnosis of endometrial cancers were reported to be abnormal 38% of the time, consistent with adenocarcinoma 21% of the time, and in 13% of cases showed atypical glandular cells. <ref name="pmid26315394">Lai CR, Hsu CY, Hang JF, Li AF (2015) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=26315394 The Diagnostic Value of Routine Papanicolaou Smears for Detecting Endometrial Cancers: An Update.] ''Acta Cytol'' 59 (4):315-8. [http://dx.doi.org/10.1159/000438975 DOI:10.1159/000438975] PMID: [https://pubmed.gov/26315394 26315394]</ref> | ||
The definitive diagnosis of endometrial cancer is accomplished by the use of histology. However, the personal and family history of the patient together with a complete physical examination are instrumental. Intrauterine pregnancy should be considered in women of reproductive age with abnormal uterine bleeding or amenorrhea unless postmenopausal status has been confirmed. If suspicious symptoms, signs, and/or family history are present, basic laboratory evaluation, cervical-vaginal Pap smear, and transvaginal TVU scanning generally are considered. Patients with an abnormal Pap smear should undergo further investigation regardless of age . <ref name="pmid28508342">{{cite journal| author=Tzur T, Kessous R, Weintraub AY| title=Current strategies in the diagnosis of endometrial cancer. | journal=Arch Gynecol Obstet | year= 2017 | volume= 296 | issue= 1 | pages= 5-14 | pmid=28508342 | doi=10.1007/s00404-017-4391-z | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28508342 }} </ref> | The definitive diagnosis of endometrial cancer is accomplished by the use of histology. However, the personal and family history of the patient together with a complete physical examination are instrumental. Intrauterine pregnancy should be considered in women of reproductive age with abnormal uterine bleeding or amenorrhea unless postmenopausal status has been confirmed. If suspicious symptoms, signs, and/or family history are present, basic laboratory evaluation, cervical-vaginal Pap smear, and transvaginal TVU scanning generally are considered. Patients with an abnormal Pap smear should undergo further investigation regardless of age . <ref name="pmid28508342">{{cite journal| author=Tzur T, Kessous R, Weintraub AY| title=Current strategies in the diagnosis of endometrial cancer. | journal=Arch Gynecol Obstet | year= 2017 | volume= 296 | issue= 1 | pages= 5-14 | pmid=28508342 | doi=10.1007/s00404-017-4391-z | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28508342 }} </ref> | ||
'''Transvaginal Ultrasound''' | |||
This is often the next step when suspicious history or physical findings are seen. In some cases, abdominal ultrasound may also be used. In women aged 35 years or younger who are diagnosed with benign gynecologic conditions or non-gynecologic etiologies and are determined to be of low risk for endometrial pathology, transvaginal ultrasound can be skipped. However, if there is a subsequent failure of medical management, transvaginal ultrasound should be performed. <ref name="pmid11296797">{{cite journal| author=ACOG Committee on Practice Bulletins--Gynecology. American College of Obstetricians and Gynecologists.| title=ACOG practice bulletin: management of anovulatory bleeding. | journal=Int J Gynaecol Obstet | year= 2001 | volume= 72 | issue= 3 | pages= 263-71 | pmid=11296797 | doi=10.1016/s0020-7292(01)00357-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11296797 }} </ref> | |||
Transvaginal ultrasound should be performed in younger women with recurrent abnormal uterine bleeding and anovulatory bleeding in women over the age of 35 years together with examination under anesthesia with dilation and curettage or endometrial sampling in an outpatient setting. Any suspicious findings warrants further investigation. | |||
'''Endocervical Sampling and Endocervical Curettage''' | |||
Endocervical sampling of endocervical curettage is sometimes done before endometrial sampling so determine if there is involvement of the cervix. Biopsies should be taken if any abnormalities are found in the cervix, vaginal, or vulva | |||
'''Hysteroscopy''' | |||
This is effective in detecting endometrial polyps, which are associated with endometrial cancer, and submucosal myomas. It can be used along in conjunction with dilation and curettage for the removal of endometrial polyps. <ref name="pmid25524536">{{cite journal| author=Gkrozou F, Dimakopoulos G, Vrekoussis T, Lavasidis L, Koutlas A, Navrozoglou I | display-authors=etal| title=Hysteroscopy in women with abnormal uterine bleeding: a meta-analysis on four major endometrial pathologies. | journal=Arch Gynecol Obstet | year= 2015 | volume= 291 | issue= 6 | pages= 1347-54 | pmid=25524536 | doi=10.1007/s00404-014-3585-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25524536 }} </ref> | |||
Revision as of 08:28, 31 October 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Monalisa Dmello, M.B,B.S., M.D. [2] Ogechukwu Hannah Nnabude, MD
Diagnosis
A thorough history and physical examination, including all systems, habits, medications, allergies, present acute and chronic illnesses and previous illnesses, significant injuries and surgeries, and a meticulous family medical-surgical history with multigeneration family cancer history, engaging cancer genetics counseling are crucial in narrowing down a diagnosis. Abnormal uterine bleeding is the most common symptom of endometrial cancer. [1] Occasionally, cervicovaginal cytology or abnormal vaginal discharge may lead to the diagnosis of endometrial cancer. Pap smears taken within 6 months prior to the diagnosis of endometrial cancers were reported to be abnormal 38% of the time, consistent with adenocarcinoma 21% of the time, and in 13% of cases showed atypical glandular cells. [2] The definitive diagnosis of endometrial cancer is accomplished by the use of histology. However, the personal and family history of the patient together with a complete physical examination are instrumental. Intrauterine pregnancy should be considered in women of reproductive age with abnormal uterine bleeding or amenorrhea unless postmenopausal status has been confirmed. If suspicious symptoms, signs, and/or family history are present, basic laboratory evaluation, cervical-vaginal Pap smear, and transvaginal TVU scanning generally are considered. Patients with an abnormal Pap smear should undergo further investigation regardless of age . [3]
Transvaginal Ultrasound This is often the next step when suspicious history or physical findings are seen. In some cases, abdominal ultrasound may also be used. In women aged 35 years or younger who are diagnosed with benign gynecologic conditions or non-gynecologic etiologies and are determined to be of low risk for endometrial pathology, transvaginal ultrasound can be skipped. However, if there is a subsequent failure of medical management, transvaginal ultrasound should be performed. [4] Transvaginal ultrasound should be performed in younger women with recurrent abnormal uterine bleeding and anovulatory bleeding in women over the age of 35 years together with examination under anesthesia with dilation and curettage or endometrial sampling in an outpatient setting. Any suspicious findings warrants further investigation.
Endocervical Sampling and Endocervical Curettage Endocervical sampling of endocervical curettage is sometimes done before endometrial sampling so determine if there is involvement of the cervix. Biopsies should be taken if any abnormalities are found in the cervix, vaginal, or vulva
Hysteroscopy This is effective in detecting endometrial polyps, which are associated with endometrial cancer, and submucosal myomas. It can be used along in conjunction with dilation and curettage for the removal of endometrial polyps. [5]
- ↑ Pessoa JN, Freitas AC, Guimaraes RA, Lima J, Dos Reis HL, Filho AC (2014). "Endometrial Assessment: When is it Necessary?". J Clin Med Res. 6 (1): 21–5. doi:10.4021/jocmr1684w. PMC 3881985. PMID 24400027.
- ↑ Lai CR, Hsu CY, Hang JF, Li AF (2015) The Diagnostic Value of Routine Papanicolaou Smears for Detecting Endometrial Cancers: An Update. Acta Cytol 59 (4):315-8. DOI:10.1159/000438975 PMID: 26315394
- ↑ Tzur T, Kessous R, Weintraub AY (2017). "Current strategies in the diagnosis of endometrial cancer". Arch Gynecol Obstet. 296 (1): 5–14. doi:10.1007/s00404-017-4391-z. PMID 28508342.
- ↑ ACOG Committee on Practice Bulletins--Gynecology. American College of Obstetricians and Gynecologists. (2001). "ACOG practice bulletin: management of anovulatory bleeding". Int J Gynaecol Obstet. 72 (3): 263–71. doi:10.1016/s0020-7292(01)00357-5. PMID 11296797.
- ↑ Gkrozou F, Dimakopoulos G, Vrekoussis T, Lavasidis L, Koutlas A, Navrozoglou I; et al. (2015). "Hysteroscopy in women with abnormal uterine bleeding: a meta-analysis on four major endometrial pathologies". Arch Gynecol Obstet. 291 (6): 1347–54. doi:10.1007/s00404-014-3585-x. PMID 25524536.