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Query: UMLS:C0476089 (endometrial cancer)
 11,379 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Endometrial cancer generally arises early with atypical uterine bleeding: its incidence is about 8-10% in presence of this symptom. Many techniques, invasive and not invasive, have been introduced for early diagnosis and they are all more or less reliable: integration of them all is the most important objective to obtain a screening program which makes some results comparable to those obtained for cervical cancer. Hysteroscopy is the only technique which allows us to have a direct vision of the uterine cavity, of all the techniques we actually use for endometrial cancer diagnosis. Also, we can carry out hysteroscopy in the day-hospital, often without anaesthesia, with little discomfort for the woman and with little risk of complications: these facts speak well for this technique. We discuss a case of a 71-year-old patient, para 1001, menarche at 13, menopause at 45, affected by a G2-G3 endometrial adenocarcinoma located in an atypical site, for which diagnosis hysteroscopy was of primary importance.
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PMID:[Usefulness of invasive diagnosis in an atypical case of endometrial carcinoma]. 1104 79

Dilatation and curettage was performed under anesthesia in outpatients in 1,837 patients aged over 26 with a history of abnormal uterine bleeding not associated with pregnancy or ovulation. Fifty-one (2.8%) patients were found to have malignant disease. Of these, 47 patients had endometrial carcinoma. An additional 111 (6.0%) patients were found to have endometrial hyperplasia. The incidence of either malignant disease or endometrial hyperplasia was 9.7% in patients over the age of 40. Complications of this method were noted in 12 (0.7%) patients; only three patients needed to stay in hospital.
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PMID:Clinical value of dilatation and curettage for abnormal uterine bleeding. 1120 2

Endometrial cancer has far too long been regarded as a simple disease to treat. As such it has generally remained in the hands of the generalist obstetrician/gynaecologist. In order to optimize the choice of surgery, careful pre-operative evaluation is essential with respect to pathology of a biopsy, radiological assessment of extent of disease and evaluation of fitness for anaesthesia. The standard procedure is a total abdominal hysterectomy and bilateral salpingo-oophorectomy. However, consideration should be given to pelvic lymphadenectomy in high-risk cases. Surgery for high-risk endometrial cancer should be performed by gynaecological oncologists.
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PMID:Surgery for endometrial cancer: what type and by whom? 1147 62

The aim of this observational clinical study was to evaluate the feasibility and diagnostic accuracy of outpatient diagnostic hysteroscopy in premenopausal patients suffering from abnormal uterine bleeding. Between September 1996 and September 1999, 819 patients were referred to our outpatient hysteroscopy clinic, 317 of which were premenopausal, and presenting with menstrual symptoms. All hysteroscopies were performed using a standard 30 degrees 5-mm hysteroscope, and the uterine cavity was generally distended with normal saline. Hysteroscopy was completed successfully in 305 cases (96.2%), but since the routine use of lidocaine spray in 1998 this figure increased up to 98.9%. Intrauterine pathology was diagnosed in almost 34% of patients, the most frequent being submucous myomas (14%) and endometrial polyps (14%); there was no case of endometrial cancer in this subset of patients. Moreover, there was an age-related distribution of intrauterine pathology, with the highest incidence in patients aged 41-50 years. Diagnostic hysteroscopy is a simple and safe technique, well accepted by the vast majority of patients; due to its excellent diagnostic accuracy, and its high success rate as an outpatient procedure, we wonder why inpatient D&C under general anesthesia is still regarded a diagnostic or even therapeutic option for patients with abnormal uterine bleeding.
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PMID:Diagnostic hysteroscopy for the investigation of abnormal uterine bleeding in premenopausal patients. 1179 Dec 82

Spinal cord injury occurs predominantly in males, and endometrial cancer in a patient with spinal cord injury is very rare. A 71-year-old woman, gravida 7, para 4, who had incomplete quadriplegia due to a spinal cord injury, was admitted with a complaint of genital bleeding. Biopsies of the cervix and the endometrium revealed endometrioid adenocarcinoma. Total abdominal hysterectomy was performed under general anesthesia. Pathohistological analysis revealed endometrial adenocarcinoma (G1) with squamous metaplasia and International Federation of Gynecology and Obstetrics (FIGO) surgical stage 2b. Local recurrence was not obvious after the surgery. However, lung metastasis appeared on postoperative day 225, and she died from dyspnea on day 277. Uterine cancer screening is more necessary in long-term bedridden women.
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PMID:Endometrial cancer of the uterus in a patient with spinal cord injury. 1286 12

Abnormal uterine bleeding is a common presenting symptom in the family practice setting. In women of childbearing age, a methodical history, physical examination, and laboratory evaluation may enable the physician to rule out causes such as pregnancy and pregnancy-related disorders, medications, iatrogenic causes, systemic conditions, and obvious genital tract pathology. Dysfunctional uterine bleeding (anovulatory or ovulatory) is diagnosed by exclusion of these causes. In women of childbearing age who are at high risk for endometrial cancer, the initial evaluation includes endometrial biopsy; saline-infusion sonohysterography or diagnostic hysteroscopy is performed if initial studies are inconclusive or the bleeding continues. Women of childbearing age who are at low risk for endometrial cancer may be assessed initially by transvaginal ultrasonography. Postmenopausal women with abnormal uterine bleeding should be offered dilatation and curettage; if they are poor candidates for general anesthesia or decline dilatation and curettage, they may be offered transvaginal ultrasonography or saline-infusion sonohysterography with directed endometrial biopsy. Medical management of anovulatory dysfunctional uterine bleeding may include oral contraceptive pills or cyclic progestins. Menorrhagia is managed most effectively with nonsteroidal anti-inflammatory drugs or the levonorgestrel intrauterine contraceptive device. Surgical management may include hysterectomy or less invasive, uterus-sparing procedures.
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PMID:Abnormal uterine bleeding. 1511 12

The main aim of investigating women with abnormal uterine bleeding is to exclude serious intrauterine pathology, particularly endometrial cancer. Endometrial assessment has traditionally been achieved by obtaining tissue for histological analysis utilising blind in-patient dilatation of the cervix and curettage of the endometrium under general anaesthesia. This procedure is now generally accepted as outmoded practice associated with unnecessary morbidity and cost and has been largely replaced by minimally invasive out-patient or 'ambulatory' diagnostic modalities. These modalities include transvaginal ultrasonography, out-patient hysteroscopy and miniature endometrial biopsy. The most controversial debate has centred on how best to image the uterine cavity with advocates of hysteroscopy and ultrasonography holding apparently implacable views. However, the concept of hysteroscopy and ultrasonography as competing tests may be misplaced, and perhaps they should be viewed as complementary diagnostic tools. To help us answer such questions requires an appraisal of the available evidence. In this way, a more rational approach to investigating women for endometrial cancer is possible based on the clinical and economic performance of hysteroscopy and ultrasonography. This review assesses the evidence and suggests approaches available to gynaecologists for the diagnostic work-up of women suspected to have endometrial cancer utilising hysteroscopy and ultrasonography.
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PMID:Hysteroscopy and ultrasonography in the diagnosis of endometrial cancer. 1645 15

Bleeding disorders encountered during administration of hormone replacement therapy (HRT) are reviewed. The incidence of bleeding disorders is dependent on the phase of HRT and the age of the patient. In the diagnosis of these bleedings transvaginal sonography and minihysteroscopy are very important methods. Endometrial thickness can be monitored exactly by transvaginal sonography. Outpatient minihysteroscopy without anesthesia results in higher compliance to HRT after the procedure. In hormonal treatment of bleeding disorders during HRT, the sonographically supported progestogen test is very useful and can reduce endometrium thickness. Operative treatments include myoma and polyp resection as well as endometrial ablation. By these methods a high rate of bleeding-free HRT can be reached. The problem of endometrial cancer during HRT is discussed on the basis of new literature and critical statements. The review shows the importance of individual diagnostic and treatment schedules for bleeding disorders during HRT.
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PMID:Hormone replacement therapy and bleeding disorders. 1683 75

A major proportion of the workload in many histopathology laboratories is accounted for by endometrial biopsies, either curettage specimens or outpatient biopsy specimens. The increasing use of pipelle and other methods of biopsy not necessitating general anaesthesia has resulted in greater numbers of specimens with scant tissue, resulting in problems in assessing adequacy and in interpreting artefactual changes, some of which appear more common with outpatient biopsies. In this review, the criteria for adequacy and common artefacts in endometrial biopsies, as well as the interpretation of endometrial biopsies in general, are discussed, concentrating on areas that cause problems for pathologists. An adequate clinical history, including knowledge of the age, menstrual history and menopausal status, and information on the use of exogenous hormones and tamoxifen, is necessary for the pathologist to critically evaluate endometrial biopsies. Topics such as endometritis, endometrial polyps, changes that are induced by hormones and tamoxifen within the endometrium, endometrial metaplasias and hyperplasias, atypical polypoid adenomyoma, adenofibroma, adenosarcoma, histological types of endometrial carcinoma and grading of endometrial carcinomas are discussed with regard to endometrial biopsy specimens rather than hysterectomy specimens. The value of ancillary techniques, especially immunohistochemistry, is discussed where appropriate.
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PMID:My approach to the interpretation of endometrial biopsies and curettings. 1687 62

The purpose of this study was to analyze the outcome of vaginal and abdominal hysterectomy for the treatment of early-stage endometrial cancer in a selected group of elder patients. This retrospective study analyzed a total of 154 patients: 113 (group I) underwent vaginal surgery and 41 (group II) underwent laparotomy. In both groups, we investigated the following parameters: intra- and postoperative complications, mean operative time, mean hospital stay, disease-free survival (DFS), overall survival (OS), and time of local or retroperitoneal recurrence. Medically compromised patients were significantly more frequent in the vaginal surgery group (P = 0.005), and the operative duration in this group was significantly shorter (P = 0.01). Intra- and postoperative complications, along with local and distant recurrence, did not show a statistically significant difference in the two groups. Total survival in the two populations, 85% at 5 years, did not reach statistically significant difference either in terms of DFS or in terms of OS. Vaginal surgery compared to traditional abdominal approach is feasible also in patients with high surgical risk; it does not require general anesthesia, abolishes abdominal trauma correlated to laparotomy, and allows a quicker reprise of the bladder and rectal function; therefore, it achieves high eradication rates and low intra- and postoperative morbidity rates.
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PMID:Vaginal versus abdominal hysterectomy in endometrial cancer: a retrospective study in a selective population. 1794 19


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