Endometrial cancer screening items

As one of the most common malignant tumors of the female reproductive system, endometrial cancer has become a killer of women. The disease is more common in postmenopausal women, but premenopausal and even younger women may also suffer from the disease. Based on the prevalence of the disease, it is necessary for us to increase our understanding of it. Let's take a look at its examination items.

1. Medical history: Endometrial cancer patients are mostly elderly women with delayed menopause or irregular menstruation. They are often infertile or have few parities, and are associated with obesity, hypertension, and diabetes. If they have irregular vaginal bleeding or foul-smelling discharge after menopause, they should be paid more attention. For young patients with irregular vaginal bleeding, the cause should also be carefully clarified, especially those who have been treated but have not been effective should also undergo curettage. Vaginal discharge and abdominal pain are already late symptoms.

2. Clinical examination: In the early stage, general gynecological examination often reveals nothing. The uterus is not large, the cervix is ​​smooth, and the appendages are normal. In the late stage of the disease, the uterus is larger than the corresponding age. Some patients may have bloody leucorrhea or rotten cancerous tissue on the finger cot after bimanual examination; some patients may have protruding polyp-like tumors at the cervical opening. However, endometrial cancer can coexist with uterine fibroids, so an enlarged uterus is not necessarily an advanced endometrial cancer.

3. Cytology: The diagnosis rate of vaginal cytology for endometrial cancer is lower than that for cervical cancer. The reasons are: ① Columnar epithelial cells do not often fall off; ② When the fallen cells reach the vagina through the cervical canal, they are often dissolved and denatured, making them difficult to identify; ③ Sometimes the cervical canal is narrow and closed, making it difficult for the fallen cells to reach the vagina. In order to improve the positive diagnosis rate, many scholars have improved the location and method of taking specimens. With the improvement of diagnostic technology, the positive diagnosis rate of endometrial cancer has also been greatly improved.

4. Ultrasound examination: Uterine ultrasound examination is of certain significance for the size, location, degree of myometrial invasion, whether the tumor penetrates the uterine serosa or involves the cervical canal of endometrial cancer, and its diagnostic consistency rate is 79% to 82%. It has been reported that the accuracy of ultrasound is about 87% for patients over 45 years old and compared with hysteroscopy and biopsy. In addition, Xie Yanggui and others performed B-ultrasound examination according to the UICC staging method, and compared with surgical exploration and pathology based on the tumor location, myometrial invasion, parauterine and adjacent organ involvement, and the staging consistency rate reached 92%. B-ultrasound examination does not cause creative and radioactive damage to patients, so it is one of the routine examinations for endometrial cancer. It has a certain reference value, especially in understanding myometrial invasion and clinical staging.

5. Diagnostic curettage: Curettage is an indispensable method for diagnosis. It is necessary not only to determine whether it is cancer, but also to determine the location of the cancer. If cervical adenocarcinoma is misdiagnosed as endometrial cancer and treated as a general hysterectomy, it is obviously inappropriate; if endometrial cancer is misdiagnosed as cervical adenocarcinoma, it is also inappropriate. However, microscopic examination cannot distinguish between cervical adenocarcinoma and endometrial cancer. Therefore, segmented diagnostic curettage is required. First, use a small curette to scrape the tissue inside the cervical canal, then enter the uterine cavity to scrape the tissues of the two sides of the uterine horns and the anterior and posterior walls of the uterine body, and bottle them separately with labels and send them for pathological examination. If there is resistance at the inner opening, the cervix can be slightly dilated to No. 5. Segmental curettage often goes too deep when scraping the cervical canal, mistaking the contents of the uterine cavity for cervical canal cancer; or endometrial cancer descends into the cervical canal, mistaking it for cervical canal cancer or uterine body cancer involving the cervical canal; or the original cervical canal cancer has too much cancer tissue, and when the small curette enters the uterine cavity, it brings in a little cervical cancer tissue and mistaking it for cervical cancer to have reached the uterine cavity. All these situations indicate that the lesions are already in a late stage, and they should be treated according to the scope of cervical cancer surgery.

6. Hysteroscopy: Due to the application of fiber light sources and the improvement of uterine distension agents, this technology, which had been stagnant for a long time, has developed again in recent years. CO2 gas distends the uterus, the field of vision is clear, and it is safe to use with a flow meter device. Hysteroscopy can not only observe the uterine cavity, but also the cervical canal, especially the microscopic uterine cavity, and the cervical canal, especially the application of microhysteroscopy, which can make the observation more detailed. The contact hysteroscope developed in recent years does not require uterine distension, making the examination simpler and safer. Under hysteroscopy, the location, size, and boundary of the tumor can be observed, whether it is localized or diffuse, whether it is exophytic or endophytic, and whether the cervical canal is involved; biopsy of suspicious lesions can help to find smaller or early lesions. The accuracy of hysteroscopy in diagnosing endometrial cancer is 94%, and that of endometrial epithelial tumor is 92%. If direct biopsy is used, the accuracy rate is 100%. Pay attention to prevent complications such as bleeding, infection, and perforation during microscopic examination.

7. Retroperitoneal lymph node angiography: It can determine whether the pelvic and para-aortic lymph nodes have metastases, which is helpful for deciding the treatment plan. In stages I and II, the positive rates of pelvic lymph nodes are 10% and 30% respectively.

The diagnosis of any disease is a major blow to the patient and his family, but what hits the family the most is that the patient has no will to live and is unwilling to fight the disease. Therefore, what patients need to do is to adjust their mentality in time and actively accept treatment. Modern medical technology is becoming more and more advanced. We have reason to believe that as long as we actively treat it, there is hope.