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Cancer of the Uterus - Diagnosis
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Contents
Work-up for Suspected Uterine MalignancySigns of suspected Abnormal Malignancy
A diagnosis of endometrial cancer will only be confirmed in 20 per cent of patients with signs of endometrial malignancy. DiagnosisDiagnosis should be performed either by
Whether additional hysteroscopy might increase the accuracy of diagnosis is unproven. Hysteroscopy might facilitate tumour cell dissemination into the peritoneal cavity, but an adverse effect of hysteroscopy on disease-free or overall survival has not yet been demonstrated. Routine Pre-operative InvestigationsRoutine pre-operative investigations include:
ScreeningThere is no accepted method for screening and early detection of endometrial cancer. In addition, 75 to 90 per cent of all patients with endometrial cancer present with abnormal uterine bleeding and early stage disease. Five year survival in these patients is about 90 per cent. As the risk of morbidity is greater than the expected benefit, mass screening of healthy women is not justified. Some authors recommend screening for women showing the following conditions:
Pap SmearsLess than 50 per cent of all women with endometrial cancer will have an abnormal Pap smear result. However, those that do return an abnormal smear will generally be found to have more advanced disease than those who return a negative Pap smear result. If the Pap smear is normal, about 6 per cent of women will have endometrial cancer. If the Pap smear is abnormal, approximately 25 per cent will have endometrial cancer. Endometrial SamplingTaken with special devices (i.e. Pipelle sampler) from the uterine cavity. There is a high failure rate because of a stenotic cervical canal in up to 20 per cent of women. False negative results can be expected in about 10 per cent of women. A fractional D&C (under anaesthesia) must be performed in a symptomatic woman with negative endometrial sampling. Transvaginal UltrasoundAlthough there is a strong correlation between the thickness of the endometrium and the risk of having endometrial cancer, no cut-off value fits the needs of clinicians. It is considered that the endometrium in post-menopausal women should not be thicker than 5mm, but a false positive rate of 15 per cent can be expected in a compliant group of patients (those 5mm or less). Dr Andreas Obermair, MD
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