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guidelines for Treatment of Endometrial Carcinoma-Endometrial Carcinoma

guidelines for Treatment of Endometrial Carcinoma-Endometrial Carcinoma
Endometrial cancer treatment compass to endometrial cancer patients to the hospital often appear questions to answer, for example: Endometrial cancer hanging what department number? What should I pay attention to before examination of endometrial cancer? What do doctors usually ask? What tests should endometrial cancer do? What do you think of the examination results of endometrial cancer? Wait. Endometrial cancer treatment guidelines are designed to facilitate patients with endometrial cancer to seek medical treatment and solve the doubts of patients with endometrial cancer.
Typical symptom
Dysmenorrhea and excessive menstruation
Suggested visiting department
Oncology, gynecology
Best visit time
Early stage of cancer
Duration of visit
Long-term inspection
Frequency of follow-up visit/diagnosis and treatment cycle
1-3 months
Preparation before seeing a doctor
Wash your genitals at home and empty your urine before seeing a doctor, that is, know the date of your last menstruation
Common consultation contents
1. Describe the reason for seeing a doctor (when did you start and what's wrong?)
2. Is the feeling of discomfort caused by obvious factors?
3. Are there any accompanying symptoms such as increased vaginal secretions?
4. Is there a history of unclean sexual intercourse?
5. Have you been to the hospital, have you done those examinations, and what are the examination results?
6. How is the treatment?
7. Is there any history of drug allergy?
8. Ask about the history of marriage and childbearing
9. Menstruation: Menstrual cycle, last menstrual time, menstrual volume, dysmenorrhea, etc.
Key inspection items
1. Cytological examination
The positive rate of cervical smear, posterior vaginal fornix smear and cervical tube aspiration smear for cytological examination in auxiliary diagnosis of endometrial carcinoma is not high
2. Histopathological examination
Histopathological examination of endometrium is the basis for the diagnosis of endometrial carcinoma, and it is also the only method to understand the pathological type and cell differentiation degree. Tissue specimen adoption is an important problem affecting the accuracy of histopathological examination. Commonly used methods for endometrial specimen adoption are: ① endometrial biopsy; Curettage of cervical canal; ③ Segmented diagnosis and curettage, which is the most commonly used and valuable method. After disinfection and bedding, first scrape the cervical canal with a small cervical curette to take the cervical canal tissue; And then use the probe, Detect the depth of uterine cavity, Finally, the uterine cavity is completely scraped, All tissues scraped out of cervical canal and uterine cavity should be fixed and sent for histopathological examination. The advantage of segmental curettage is that it can distinguish endometrial cancer from cervical adenocarcinoma, It can also be clear whether endometrial cancer involves cervical canal, Assisting clinical staging (ⅰ, Phase II), to provide the basis for the formulation of treatment plan, Clinicians should pay attention to strictly abide by the surgical procedures, Avoid leakage and mixing of scraping flow in cervical canal and uterine cavity, In terms of assisting in staging, It is difficult to diagnose whether cervical cancer is involved or not by scraping specimens of endometrial cancer. The clinical examination level and experience of obstetricians and gynecologists will affect the accuracy of segmented diagnosis to a certain extent, Some scholars in China reported that 69 cases of endometrial carcinoma were diagnosed by segmental pathological specimens, compared with postoperative hysterectomy specimens, the false positive rate was 34.5%, and the false negative rate was 12.68% (the total error rate was 47.2%). For patients with obvious lesions in the uterine cavity, uterine biopsy (suction and curettage) and cervical tube curettage were the simplest and feasible in outpatient service.
3. Hysteroscopy
At present, hysteroscopy has been widely used in the diagnosis of endometrial diseases, Fiberoptic hysteroscopy is the most widely used in China, About 20% of postmenopausal vaginal bleeding patients are endometrial cancer, Hysteroscopy can directly observe the cervical canal and uterine cavity, Find the lesion and take biopsy accurately, It can improve the diagnosis rate of biopsy, avoid missed diagnosis by routine diagnosis and curettage, and provide information such as lesion scope and whether cervical canal is involved, so as to assist in correct clinical staging before operation. However, due to the injection of uterine dilatation fluid during hysteroscopy, it may flow into pelvic cavity through fallopian tube, resulting in the spread of cancer cells and affecting prognosis, which should be paid attention to.
Diagnostic criteria
Diagnostic steps of endometrial cancer 1. Pay attention to the collection of medical history of factors related to the incidence of endometrial cancer.A long history of endometrial hyperplasia, Persistent anovulation in young women (infertility and polycystic ovary syndrome), Ovarian sex cord stromal tumors (granulosa cell carcinoma and theca cell tumor), external estrogen or long-term hormone replacement therapy, etc., and those who have a long-term history of tamoxifen after breast cancer surgery should be highly vigilant against the existence of endometrial cancer, should be further examined, and should comprehensively collect the history of internal diseases, such as diabetes and hypertension. 2. Determine the diagnosis and clinical stage according to the results of medical history, clinical examination, pathological examination and various auxiliary examinations. 3. According to the results of pathological examination and other auxiliary examinations, the preoperative clinical staging diagnosis (according to FIGO standard) and the pathological diagnosis of positive cervical canal curettage (diagnosis and curettage) were made.


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