Differential diagnosis between uterine bleeding and uterine cancer

The most common symptom of differential diagnosis of endometrial cancer is postmenopausal bleeding or perimenopausal bleeding, so it needs to be differentiated from other diseases that cause vaginal bleeding. The diagnosis of uterine cancer requires many tests and cannot be identified only by the symptoms. There are many diseases with similar symptoms to uterine cancer. Once misdiagnosed, the impact may be life-threatening, so it is necessary to carefully distinguish uterine cancer from other gynecological diseases.

1. Dysfunctional uterine bleeding

Perimenopausal functional uterine bleeding is characterized by prolonged menstruation, increased menstrual flow, or irregular vaginal bleeding, which are the same symptoms as endometrial cancer. Therefore, for such patients, even if there are no positive findings in the gynecological examination, segmented curettage and pathological examination should be performed to exclude endometrial cancer before symptomatic treatment. Young women with irregular vaginal bleeding, especially those with infertility, oligomenorrhea, or polycystic ovary syndrome, should also be cautious. If the endometrium is thickened or the echo is uneven on B-ultrasound, segmented curettage and pathological examination should also be performed to exclude endometrial cancer or precancerous lesions.

2. Senile vaginitis

Common in postmenopausal women, manifested as bloody leucorrhea. Physical examination shows that the vaginal mucosa is atrophic and thin, congested, with bleeding spots and inflammatory secretions, which can improve after symptomatic treatment. For such patients, B-ultrasound and cervical cytology should be performed to exclude endometrial lesions and cervical lesions before they can be treated as senile vaginitis.

3. Senile endometritis combined with intrauterine pyometra

It is often manifested by vaginal discharge of pus, blood or purulent blood. The patient may have fever, the uterus is often enlarged and softened, and there is tenderness. After the cervix is ​​dilated, pus flows out. Segmental curettage only shows inflammatory infiltrated tissue. For elderly women, intrauterine pyometra often coexists with cervical canal cancer or endometrial cancer, and care must be taken when distinguishing them.

4. Endometrial polyps or submucosal uterine fibroids

Symptoms include excessive or prolonged menstruation, or bleeding accompanied by vaginal discharge or bloody secretions. The clinical manifestations are very similar to endometrial cancer. B-ultrasound, hysteroscopy, polyp or myoma removal, and segmental curettage can be used for diagnosis and treatment.

5. Cervical cancer, uterine sarcoma and fallopian tube cancer

Like endometrial cancer, it also presents with irregular vaginal bleeding and discharge. Endocervical adenocarcinoma may cause the cervical canal to thicken and harden into a barrel shape, which can be diagnosed through segmental curettage, pathological examination and immunohistochemistry. Uterine sarcoma causes the uterus to enlarge and soften in a short period of time. A uterine mass can be felt during physical examination, and color Doppler ultrasound examination can help with diagnosis. Fallopian tube cancer has paroxysmal vaginal discharge, vaginal bleeding, and abdominal pain as its main symptoms. A mass in the adnexal area can be felt during physical examination, and B-ultrasound or laparoscopy can help with diagnosis.

Warm reminder: Change your lifestyle habits, control your diet, increase exercise, and reduce the incidence of endometrial cancer by controlling the occurrence of "rich diseases" such as high blood pressure, diabetes, and obesity.