Post Date November, 16 2024
Endometrial cancer is a familiar gynecological disease and a serious malignant tumor. We need to be aware of its symptoms and achieve early detection, examination, and treatment.
Staging of endometrial cancer
Grade I: Highly differentiated cancer, often limited to the endometrium, occasionally with single or multiple layers of papillary epithelium, irregularly arranged and may appear in a block like manner, with reduced stroma.
Grade II: moderately differentiated cancer, with unclear glandular contours and some appearing as cancerous masses; Cell polarity disappears and nuclear division is common.
Grade III: Cancer cells, which are mainly composed of cancer masses and sometimes require connective tissue staining to differentiate from sarcomas, invade the stroma and penetrate into the muscle layer.
Grade IV: In order to significantly differentiate undifferentiated cancer, the cancer cells are immature, lack differentiation, and atypical differentiation, with obvious mitotic figures.
Symptoms of endometrial cancer
1. Irregular bleeding: Vaginal bleeding is the main symptom of endometrial cancer, often in small to moderate amounts. Young women and women with amenorrhea often mistake menstrual irregularities for neglect. After menopause, women mainly exhibit continuous or intermittent vaginal bleeding. Some patients only exhibit a small amount of vaginal bloody discharge after amenorrhea. Late stage patients may mix rotting fleshy tissue with bleeding.
2. Vaginal discharge: Some patients have varying degrees of vaginal discharge. In the early stage, it can manifest as thin white secretions or a small amount of bloody vaginal discharge, combined with infection or cancer furnace necrosis, and purulent secretions with a strange odor. Sometimes vaginal discharge can accompany tissue samples.
3. Pain: Cancer stoves and the bleeding they cause stimulate uterine contractions, causing paroxysmal abdominal pain. After amenorrhea, cervical stenosis in women can cause poor drainage of uterine secretions, leading to secondary infection and accumulation of pus in the uterine cavity. Patients can experience severe lower abdominal pain and fever. The late stage cancer tissue of the tumor infiltrates the entire layer of the uterus, or invades the adjacent connective tissue, cervical ligaments, bladder, intestines, or compresses the pelvic wall tissue or nerves, causing persistent and gradually worsening pain, accompanied by lumbosacral pain or radiating to the lower limbs on the same side.
4. Abdominal mass: Early endometrial cancer generally cannot contact the abdominal mass. When endometrial cancer combines with large uterine fibroids, or in the late stage, there is pus accumulation in the uterine cavity, which metastasizes to the pelvic and abdominal cavity to form a huge mass (ovarian metastasis, etc.), the abdomen may come into contact with the mass, which is generally solid, with poor mobility, and sometimes tenderness.
5. Other: Late stage tumor infiltration and compression of iliac vessels can cause edema and pain in the ipsilateral lower limbs; Invasion of the lesion compresses the ureter, causing ipsilateral hydronephrosis in the renal pelvis and ureter, and even leading to renal atrophy; Continuous bleeding can lead to secondary anemia; Long term tumor depletion can lead to symptoms of systemic failure such as weight loss, fever, and cachexia.
Endometrial cancer examination
1. Medical history: Patients with endometrial cancer are mostly elderly women, with delayed menopause or irregular menstruation; It is often infertile or has a small number of births, combined with obesity, hypertension and diabetes; If there is irregular vaginal bleeding or foul discharge after menopause, it is more appropriate to pay attention. For young patients with irregular vaginal bleeding, it is also important to carefully understand the cause, especially for those who have failed treatment and should also undergo curettage. Vaginal discharge and abdominal pain are already late symptoms.
2. Clinical examination: Early general gynecological examination often reveals that the uterine body is small, the cervix is smooth, and there are no abnormalities in the appendix. In the late stage of the disease, the uterus is older than the corresponding age. Some cases may have bloody white discharge or decaying cancer tissue attached to the fingertips after double diagnosis, while others may see protruding polyp like masses at the cervix. However, endometrial cancer can coexist with uterine fibroids, so those with an oversized uterus may not necessarily be advanced endometrial cancer.
3. Cytology examination: The diagnostic rate of vaginal cytology examination for endometrial cancer is lower than that for cervical cancer. The reasons are: ① columnar epithelial cells do not often shed; ② exfoliated cells dissolve, denature, and are not easily recognized when they reach the vagina through the cervical canal; ③ sometimes the cervical canal is narrow and blocked, making it difficult for exfoliated cells to reach the vagina. In order to improve the positive diagnosis rate, many scholars have improved the location and method of using specimens, and with the improvement of diagnostic technology, the positive diagnosis rate of uterine thyroid cancer has also significantly increased.
4. Ultrasound examination: Uterine ultrasound examination is meaningful for the size, location, myometrial infiltration, whether the tumor passes through the uterine serosa, and whether it involves the cervical canal of endometrial cancer. The diagnostic qualification rate reaches 79.3~81.82%. According to reports, the accuracy of ultrasound examination for patients over 45 years old is approximately 87% compared to hysteroscopy and biopsy. In addition, Xie Yanggui and others referred to the UICC segmentation method for ultrasound examination, and based on the tumor site, muscle immersion, involvement of adjacent organs, and compared with surgical examination and pathology, the segmentation rate reached 92.9%. Ultrasound examination does not cause creative or radiation damage to patients and is one of the routine examinations for endometrial cancer. Especially in understanding the infiltration and clinical segmentation of the muscle layer, it has certain reference value.
5. Diagnostic curettage: curettage examination is an indispensable method for diagnosis. Not only should it be clear whether it is cancer, but also the location of cancer growth. Cervical adenocarcinoma is misdiagnosed as endometrial cancer, and general hysterectomy treatment is obviously not suitable. Endometrial cancer, which is misdiagnosed as cervical adenocarcinoma, is also not suitable for treatment. But microscopic examination cannot distinguish between cervical adenocarcinoma or endometrial cancer. Therefore, it is necessary to conduct diagnosis in stages. First, use a small curette to scrape the tissue inside the cervical canal, and then enter the noisy cavity to scrape the tissue from both sides of the uterus and the anterior and posterior walls of the uterus. Bottle them separately and label them for pathological examination. If the inner mouth is affected and there is resistance, the cervix can expand to size 5. Segmental curettage often involves scraping the cervical canal too deeply, mistaking the contents of the uterine cavity for cervical cancer; Or endometrial cancer that protrudes into the cervical canal is mistaken for cervical canal cancer or uterine body cancer involving the cervical canal; Or it was originally cervical cancer, with too much cancer tissue. When the small curette enters the uterine cavity, it brings in some cervical cancer tissue and mistakenly recognizes that cervical cancer has reached the uterine cavity. All situations indicate that the lesion is relatively late and should be treated according to the scope of cervical cancer surgery.
6. Hysteroscopy examination: Due to the application of fiber light sources and changes in dilators, this early stagnant technique has developed again in recent years. CO2 gas expansion palace, clear vision, prepared flow meter device, safe to use. Hysteroscopy can not only observe the uterine cavity, but also observe the cervical ducts, especially the microscopic uterine cavity. It can also observe the cervical ducts, especially the application of microscopic hysteroscopy, which provides more detailed observation. The contact hysteroscopy developed in recent years does not require dilation of the uterus, making the examination simpler and safer. Under hysteroscopy, suspicious lesions such as the location, size, limited or diffuse boundaries of the cancer, appearance or internal shape, and involvement of the cervical canal can be observed. Biopsy can help detect small or early lesions. The accuracy of hysteroscopy in diagnosing endometrial cancer is 94%, and that of endometrial epithelial tumors is 92%. Using direct biopsy, the accuracy reaches 100%. Pay attention to preventing complications such as bleeding, infection, and perforation during microscopic examination.
7. Retroperitoneal lymphography: It can determine whether there is metastasis in the pelvic and paraaortic lymph nodes, which is conducive to determining the treatment plan. I. In stage II, the positive rates of pelvic lymph nodes were 10.6% and 36.5%, respectively.
Signs of endometrial cancer
1. Gynecological examination showed that there were mostly no significant changes in the pelvic reproductive organs in the early stage, with about 40% of cases having a normal uterus. If there were fibroids or lesions in the late stage, the uterus would increase. Postmenopausal women should be particularly vigilant as their uterus does not show atrophy but instead becomes plump and hardened. The ovaries may be normal or enlarged, or may be accompanied by feminized tumors. When making a double diagnosis, the patient is obese, in pain, or lacks cooperation, and there is no need to argue that the basis for a clear diagnosis is not based on the size of the uterus. Most patients have no visible cervical lesions. Only in the late stage of cervical invasion, it can be seen that the tissue protrudes from the cervical opening. After cervical involvement with infiltrating system next to the uterus.
2. Systemic manifestations: quite a few patients have diabetes, hypertension or obesity. Anemia occurs in patients with prolonged bleeding. The patient may develop malignant disease in the late stage due to cancer depletion, pain, decreased appetite, fever, etc.
3. Metastatic lesions: Late stage patients may come into contact with swollen, hardened or melted lymph nodes in the groin, or signs of metastasis such as lung and liver.
