What Is Endometrial Adenocarcinoma?

Endometrial adenocarcinoma

The diagnosis of endometrial cancer according to the above steps is generally not difficult, but sometimes it can be confused with other diseases and delay the diagnosis. Postmenopausal bleeding should be distinguished from the following situations. First of all, we should be vigilant about whether it is a malignant tumor. Although the proportion of malignant tumors in postmenopausal bleeding has decreased greatly with the development of the age. As reported by Knitis et al., Malignant diseases in vaginal bleeding after menopause in the 1940s accounted for 60 to 80%, peaked in the 1970s to 25 to 40%, and fell to 6 to 7% in the 1980s. Domestic reports such as Su Yingkuan and others, malignant diseases accounted for 76.2% in the 1960s, and endometrial cancer accounted for 12.9%.

Endometrial adenocarcinoma disease name

Endometrial adenocarcinoma

Classification of endometrial adenocarcinoma

Obstetrics and Gynecology

Endometrial glandular cancer signs

Endometrial cancer staging:

Stage I: Ia: The lesion is limited to the endometrium. Ib: Lesion infiltration is less than 1/2 muscle layer. Ic: Lesion infiltration is greater than 1/2 muscle layer.

Stage II: IIa: The lesion only infiltrates the cervical glands. b: lesion immersion and cervical interstitial.

Stage III: IIIa: Lesions invade the uterine serosa and / or appendages and / or abdominal cytology. IIIb: Vaginal metastasis. IIIc: metastasis to pelvic and / or abdominal para-aortic lymph nodes.

Stage IV: IVa: The lesion involves the bladder and / or intestinal mucosa. IVb: distant metastases, including extraperitoneal and / or inguinal lymph nodes.

Endometrial adenocarcinoma diagnostic test

1. There are many irregular vaginal bleeding, bloody or serous secretions in the history, especially postmenopausal bleeding, and later cases may have pain symptoms.

2. On examination, there are often no clear positive signs. About half of the cases may have mild uterine enlargement, and the uterine body may feel slightly softer when palpated.

3 Endometrial histology was used as the basis for diagnosis. Segmented curettage is generally used, and tissues scraped from the cervical canal and uterine cavity are sent for examination to assist in determining the extent of the lesion.

4 Intrauterine suction smear for cytology.

5. Hysteroscopy can take a biopsy of a suspicious site under direct vision to improve the diagnostic accuracy.

6. B-ultrasound, CT, and MRI examinations can assist in determining the depth of tumor-infiltrated muscularis and lymphatic metastasis.

7. Lymphography can help find lymphatic metastases.

8. Endometrial cancer staging:

Stage I: Ia: The lesion is limited to the endometrium. Ib: Lesion infiltration is less than 1/2 muscle layer. Ic: Lesion infiltration is greater than 1/2 muscle layer.

Stage II: IIa: The lesion only infiltrates the cervical glands. b: lesion immersion and cervical interstitial.

Stage III: IIIa: Lesions invade the uterine serosa and / or appendages and / or peritoneal cytology. IIIb: Vaginal metastasis. IIIc: metastasis to pelvic and / or abdominal para-aortic lymph nodes.

Stage IV: IVa: The lesion involves the bladder and / or intestinal mucosa. IVb: distant metastases, including extraperitoneal and / or inguinal lymph nodes

Endometrial adenocarcinoma treatment options

1. In the first stage, extensive uterine, double appendage, pelvic and para-aortic lymph node resections were performed extensively. After laparotomy, abdominal lavage fluid should be taken for cytological examination.

2. Stage was performed before the intraoperative cavity irradiation followed by extensive or extensive whole uterus, double appendages, and pelvic cavity. Abdominal aortic lymph nodes were resected. If lymph node metastases were present, external radiation should be supplemented after surgery.

3 Stage is still striving for extensive excision of the whole uterus, double appendages and lymph nodes, and preoperative and postoperative radiotherapy can be added.

4 For advanced or recurrent cancer, those with difficulty in surgery can choose radiotherapy, chemotherapy and hormone therapy.

5. Progesterone treatment can be used for the determination of estrogen and progesterone receptors. Receptors are positive: (1) megestrol, 100 mg, orally, 1 / d. (2) Progesterone hexanoate, 500 mg, intramuscularly, 1 / d, 250 mg intramuscularly, 1 / d after 1 month. (3) Megestrol, 40-80 mg, orally, 1 / d.

Endometrial Adenocarcinoma Care Tips

1. Cereal breakfast can prevent endometrial adenocarcinoma.

2. Taking birth control pills can reduce the risk of endometrial adenocarcinoma.

Endometrial adenocarcinoma Who is susceptible to endometrial adenocarcinoma?

The incidence of endometrial adenocarcinoma is often related to its physiology, work environment, and diet. General obese, infertility, menstrual disorders and other people are prone to endometrial adenocarcinoma.

Differential diagnosis of endometrial adenocarcinoma

In the late 1980s, Huang Hefeng and others reported that malignant diseases accounted for 22.7%, while endometrial cancer accounted for 45.5% of malignant cases, and cervical cancer accounted for 43.6%. Zheng Ying and others reported that malignant diseases accounted for 24.9% (benign 73.3%), ranking second in postmenopausal bleeding. From the age of menopause, 14% of menopause 5 years, and 68.3% of menopause 5-15 years. It can be seen that with the progress of the era in malignant tumors, endometrial cancer has an upward trend. Huang Hefeng's report even surpassed cervical cancer. Postmenopausal bleeding is not necessarily proportional to the degree of canceration. The amount of bleeding may be small, the number of bleedings may not be large and the cancerous lesions may already be obvious. Therefore, a gynecological examination should be done carefully to find out whether there are abnormalities in the vagina, cervix, uterus, and accessories. Because there may be more than two lesions at the same time, such as senile vaginitis and endometrial cancer, you must not ignore further examination because one lesion has been found. In addition to cytology, segmented diagnosis and curettage is an indispensable diagnostic step, because the diagnosis of endometrial cancer with diagnostic curettage is as high as 95%. Domestic Cheng Weiya reported that 448 cases of postmenopausal uterine bleeding were diagnosed with scraping endometrium in 10 years, of which endometrial cancer accounted for 11.4% (51 cases), Luo Qidong et al. Reported 8.7%. The literature reports range from 1.7 to 46.6%, and are generally below 15%.

Second, dysfunctional uterine bleeding often occurs in menopause menstrual disorders, especially those with more frequent uterine bleeding, regardless of whether the size of the uterus is normal, you must first do a curettage, clear the nature before treatment. Endometrial cancer can be born during the fertility period or even early women. Shandong Provincial Hospital had different endometrial cancer patients, only 26 years old, after 3 years of menstruation, the treatment of functional uterine bleeding was invalid, and the final diagnosis and curettage confirmed as endometrial cancer. Therefore, young women with irregular uterine bleeding for 2 to 3 months should not be diagnosed and diagnosed.

3. Atypical endometrial hyperplasia is more common in women of childbearing age. Endometrial dysplasia is severe in tissue morphology and sometimes difficult to distinguish from well-differentiated adenocarcinoma. Usually the endometrium is atypical hyperplasia, pathologically it can be focal, with flattened normal epithelium, cell differentiation is better, or squamous metaplasia can be seen, fertilizer stained with lotus color, no necrotic infiltration and other manifestations. Endometrial adenocarcinomas have large nuclei, increased chromatin, deep staining, poor cell differentiation, more nuclear division, less cytoplasm, and often necrosis and infiltration. And differentiated from well-differentiated early-stage endometrial adenocarcinoma: Atypical hyperplasia often has complete surface epithelium, but adenocarcinoma does not, so if you see a more complete or flattened surface epithelium, endometrial adenocarcinoma can be excluded. In addition, endometrial adenocarcinoma often has necrosis and hemorrhage. Drug treatment response is different, atypical hyperplasia, the drug dose is small, that is, slower, long-lasting, once the drug is stopped may relapse quickly; age: more young people Considering atypical hyperplasia, challengers are more likely to consider the possibility of endometrial adenocarcinoma.

Fourth, submucosal osteoma or endometrial polyps often show more menstruation or prolonged menstruation, or bleeding can be accompanied by vaginal drainage or bloody secretions, the clinical manifestations are very similar to endometrial cancer. However, differential diagnosis can be made by exploring the uterine cavity, segmented curettage, uterine lipiodolography, or hysteroscopy.

5. Cervical cancer, like endometrial cancer, also shows irregular vaginal bleeding and increased drainage. If the pathological examination is squamous cell carcinoma, it is considered to originate from the cervix. If it is an adenocarcinoma, it will be difficult to identify the source. If a mucus gland can be found, it is more likely to originate in the neck canal. Okudaira et al. Of Japan pointed out that in invasive cervical adenocarcinoma tissues, the positive expression rate of carcinoembryonic antigen (CEA) is very high. Therefore, CEA immunohistochemical staining can help distinguish cervical adenocarcinoma from endometrium.

6. For primary fallopian tube cancer, vaginal drainage, vaginal bleeding, and lower abdominal pain, vaginal smears may find cancer cells and are similar to endometrial cancer. Endometrial biopsy of fallopian tube cancer is negative, and lumps can be palpable, which is different from endometrial cancer. If the mass is small but not palpable, the diagnosis can be confirmed by laparoscopy.

Seven, senile endometritis with pyogenic empyema often manifests as vaginal discharge of pus, bloody or purulent drainage, and the uterus is often enlarged and softened. Examination from B and then expansion of uterine cancer tissue, only inflammatory infiltrating tissue was seen. Uterine empy often coexists with cervical canal cancer or endometrial cancer, and care must be taken during identification.