how to diagnose and differentiate endometrial cancer-endometrial cancer is easily confused
- Examination Of Endometrial Cancer, Diagnosis Of Endometrial Cancer
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Differential diagnosis of endometrial carcinoma
The disease must be distinguished from the following diseases:
First, postmenopausal bleeding
First of all, we should be alert to whether it is malignant tumor, although the proportion of malignant tumor in postmenopausal hemorrhage has greatly decreased with the progress of years. As reported by Knitis, malignant diseases accounted for 60 ~ 80% of postmenopausal vaginal bleeding in the 1940s, increased to 25 ~ 40% in the 1970s, and decreased to 6 ~ 7% in the 1980s. Su Yingkuan reported that malignant diseases accounted for 76.2% and endometrial cancer accounted for 12.9% in 1960s. At the end of 1980s, Huang Hefeng 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 et al. reported that malignant diseases accounted for 24.9% (benign diseases accounted for 73.3%), ranking second in postmenopausal bleeding. From the menopausal years, 14% of them were menopausal for 5 years, and 68.3% were menopausal for 5 ~ 15 years. It can be seen that endometrial cancer has an upward trend with the progress of malignant tumors. 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 bleeding is not much, and the cancer lesion may already be obvious. Therefore, gynecological examination should be done carefully to find out whether there are abnormal situations in vagina, cervix, uterine body and accessories. Because there may be more than two kinds of lesions exist at the same time, such as senile vaginitis and endometrial cancer, so we must not neglect further examination because we have found a lesion. Besides cytological examination, segmental curettage is an indispensable diagnostic step, because the diagnosis rate of endometrial cancer after diagnostic curettage is as high as 95%. Cheng Weiya reported that 448 cases of postmenopausal uterine bleeding were diagnosed and scraped endometrium in 10 years, among which endometrial cancer accounted for 11.4% (51 cases), and Luo Qidong reported 8.7%. It is reported in literature that it ranges from 1.7% to 46.6%, and generally it is below 15%.
Second, dysfunctional uterine bleeding
Menstrual disorder often occurs during menopause, especially those with frequent uterine bleeding. No matter whether the uterus is normal or not, it is necessary to make diagnosis and scraping first, and then treat it after clarifying its nature. Endometrial cancer can be born in women during the reproductive period or even at the early stage of childbirth. There were different patients with endometrial cancer in Shandong Provincial Hospital, who were only 26 years old and had menorrhagia for 3 years. The treatment of functional uterine bleeding was ineffective, and the final diagnosis was confirmed as endometrial cancer by curettage. Therefore, if the treatment of irregular uterine bleeding in young women is ineffective for 2 ~ 3 months, it should also be diagnosed and scraped to identify the situation.
Third, atypical hyperplasia of endometrium
It is more common in women of childbearing age. Endometrial atypical hyperplasia is severe in histomorphology, and sometimes it is difficult to distinguish it from well-differentiated adenocarcinoma. Usually, endometrium is atypical hyperplasia, which can be manifested as focal in pathology, with flattened normal epithelium, good cell differentiation, or squamous metaplasia, lotus color stained with fat pulp, and no necrosis and infiltration. However, the cancer cells of endometrial adenocarcinoma have large nucleus, increased chromatin, deep staining, poor cell differentiation, more mitosis, less cytoplasm, and often necrosis and infiltration. Differentiation from well-differentiated early endometrial adenocarcinoma:
(1) Atypical hyperplasia often has complete surface epithelium, while adenocarcinoma does not, so if you see more complete or compressed surface epithelium, endometrial adenocarcinoma can be excluded. In addition, endometrial adenocarcinoma often has necrosis and bleeding;
② For patients with different drug treatment reactions and atypical hyperplasia, the drug dose is small, that is, the effect is slow and the duration is long, and once the drug is stopped, it may recur quickly;
③ Age: Atypical hyperplasia is more considered in young people, and endometrial adenocarcinoma is more considered in challengers.
Fourth, uterine submucous osteoma or endometrial polyp
Most of them show menorrhagia or prolonged menstruation, or bleeding can be accompanied by vaginal drainage or bloody secretion, and their clinical manifestations are very similar to endometrial carcinoma. However, differential diagnosis can be made by exploring uterine cavity, curettage, lipiodol radiography or hysteroscopy.
V. Cervical canal cancer
Like endometrial carcinoma, it also shows irregular vaginal bleeding and increased drainage. If pathological examination is squamous cell carcinoma, it is considered to come from cervix. If it is adenocarcinoma, it will be difficult to identify its origin. If mucous glands can be found, it is more likely to originate in cervical canal. Okudaira of Japan pointed out that the positive expression rate of carcinoembryonic antigen (CEA) is very high in invasive cervical adenocarcinoma. Therefore, CEA immunohistochemical staining is helpful to distinguish cervical adenocarcinoma from endometrium.
VI. Primary fallopian tube cancer
Vaginal drainage, vaginal bleeding and lower abdominal pain, vaginal smear may find cancer cells similar to endometrial cancer. However, the endometrial biopsy of fallopian tube cancer is negative, and the tumor can be palpated beside the uterus, which is different from endometrial cancer. If the mass is small and palpable, it can be diagnosed by laparoscopy.
Seven, senile endometritis complicated with pyorrhea
It is often manifested as vaginal discharge of pus, bloody or purulent blood discharge, and uterus increases and becomes soft. After examination from B, the uterine cancer tissue was dilated, only inflammatory infiltrating tissue was seen. Uterine pyosis often coexists with cervical canal cancer or endometrial cancer, which must be paid attention to when differentiating.
VIII. Senile vaginitis
The main manifestation is bloody leucorrhea. During examination, vaginal mucosa becomes thinner, congested or has bleeding spots, secretion increases, etc., which can be improved after treatment. If necessary, anti-inflammatory treatment can be performed first, and then diagnostic curettage can be performed to exclude endometrial cancer.
IX. Submucous myoma or endometrial polyp of uterus
If there are symptoms of menorrhagia or prolonged menstruation, the diagnosis can be confirmed by B-mode ultrasound examination, hysteroscopy and segmental curettage.
Postmenopausal and perimenopausal vaginal bleeding is the most common symptom of endometrial cancer, so endometrial cancer should be differentiated from various diseases causing vaginal bleeding. Gynecological examination should exclude bleeding from vulva, vagina and cervix and bleeding and drainage caused by injury and infection. Attention should be paid to the size, shape, mobility, softness and hardness of uterus, whether there is any change in softness and hardness of cervix and parauterine tissues, and whether there are masses and thickening of appendages should be carefully and comprehensively examined.
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