Diagnostics

• Procedures

  • Endometrial sampling: most commonly performed as part of a pelvic exam

  • Hysteroscopy-guided biopsy

  • Dilatation and curettage

• Results

  • 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.

• Transvaginal ultrasonography

  • Considered to be the first diagnostic step by some experts since it is noninvasive and enables initial assessment

  • Findings

    • 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)

• CBC: anemia

• Coagulation studies: assessing other possible causes of heavy uterine bleeding

There is no routine screening test for endometrial cancer.

• Prevalence: most frequent form

• Types

  • 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)

• Histology findings

  • 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.