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Essentials of Diagnosis
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Abnormal uterine bleeding is the presenting sign in 90% of cases
Papanicolaou smear is frequently negative
After a negative pregnancy test, endometrial tissue is required to confirm the diagnosis
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General Considerations
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Adenocarcinoma of the endometrium is the second most common cancer of the female genital tract
Occurs most often in women 50–70 years of age
Risk factors
Obesity
Nulliparity
Diabetes mellitus
Polycystic ovaries with prolonged anovulation
Unopposed estrogen therapy
Extended use of tamoxifen for the treatment of breast cancer
Women with a family history of colon cancer (hereditary nonpolyposis colorectal cancer, Lynch syndrome) are at significantly increased risk, with a lifetime incidence as high as 30%
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Abnormal uterine bleeding is the presenting sign in 90% of cases
Any postmenopausal bleeding requires investigation
Pain generally occurs late in the disease, with metastases or infection
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Papanicolaou smears of the cervix
Endocervical and endometrial sampling is the only reliable means of diagnosis
Simultaneous hysteroscopy can be a valuable addition in order to localize polyps or other lesions within the uterine cavity
Pelvic ultrasonography may be used to determine the thickness of the endometrium as an indication of hypertrophy and possible neoplastic change
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Total hysterectomy and bilateral salpingo-oophorectomy
Peritoneal washings for cytologic examination are routinely taken and lymph node sampling may be done
Women with high-risk endometrial cancer (serous adenocarcinoma, clear cell carcinoma, grade 3 deeply invasive endometrioid carcinoma, and stages III/IV disease) are generally treated with surgery followed by chemotherapy and/or radiation therapy
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With early diagnosis and treatment, the overall 5-year survival is 80–85%
With stage I disease, the depth of myometrial invasion is the strongest predictor of survival, with a 5-year survival of
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Bodurtha
Smith AJ
et al. Sentinel lymph node assessment in endometrial cancer: a systematic review and meta-analysis. Am J Obstet Gynecol. 2017 May;216(5):459–76.
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McDonald
ME
et al. Endometrial cancer: obesity, genetics and targeted agents. Obstet Gynecol Clin North Am. 2019 Mar;46(1):89–105.
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Passarello
K
et al. Endometrial cancer: an overview of pathophysiology, management and care. Semin Oncol Nurs. 2019 Apr;35(2):157–65.
[PubMed: 30867105]
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Visser
NCM
et al. Accuracy of endometrial ...