Describe the procedure and results of endometrial biopsy with histology.
Endometrial sampling: most commonly performed as part of a pelvic exam
Dilatation and curettage
Endometrial hyperplasia, with or without atypia
Pronounced proliferation of disorganized glandular tissue (characteristic of endometrial adenocarcinoma)
If there is no detectable pathology on biopsy and if no further symptoms occur, endometrial cancer can be ruled out.
Describe imaging modalities.
Considered to be the first diagnostic step by some experts since it is noninvasive and enables initial assessment
Thickening of the endometrium
Cystic changes, variable echogenicity
Possibly visible tumor infiltration into neighboring organs
Regular monitoring required in postmenopausal women with endometrial thickening ≥ 5 mm
Abdominal ultrasonography: A complete abdominal ultrasound is indicated to exclude metastasis.
Chest x-ray, CT, MRI: assessment of metastatic spread (lungs, pelvis)
Describe laboratory tests.
Coagulation studies: assessing other possible causes of heavy uterine bleeding
There is no routine screening test for endometrial cancer.
Describe the histology of endometrioid adenocarcinoma.
Prevalence: most frequent form
Type I endometrial carcinoma includes estrogen-dependent endometrioid adenocarcinoma (grade 1 and 2; the most common)
Type II endometrial carcinoma includes estrogen-independent endometrioid adenocarcinoma (grade 3; rare, poor prognosis)
Pronounced glandular proliferation, which presents as atypical glandular tubes
The glands are positioned, in part, back-to-back ("dos-à-dos") with no separating stroma
Lined with pseudostratified epithelial cells, the nuclei of which are enlarged in an atypical vesicular form.
These glandular cells frequently demonstrate mitosis.
Tumor cell nests may also be observed and infiltrate the myometrium in high-grade tumors.