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Diagnostics of uterine cancer

The patient is examined by vaginal ultrasound, and in case of symptoms, a specimen is taken for histological evaluation.

For confirmed uterine cancer, information on the histological type, grade of differentiation, and possible infiltration of the cervix should be collected. It must also be determined if there is metastasis outside the uterus. A pipelle specimen is often suffisient to confirm the histology and degree of differentiation. If this information is not present, dilatation and curettage (D&C) must be performed. 

MRI gives a good impression of how deeply the tumor infiltrates the uterine wall and the cervix, as well as the involvement of the lymph nodes in the pelvis and paraaortic areas. (11-12). Preoperative evaluation of tumor infiltration into the cervix is best confirmed by MRI. D&C does not always provide reliable information regarding this.

Examinations 

  • Gynecological examination under general anesthesia with D&C for evaluation of histological type and grade of differentiation. This is done if this information is not available from the endometrial biopsy. 
  • MRI of the abdomen and pelvis for assessment of the extension of the tumor, as well as possible metastases
  • Chest X-ray

The goal of the MRI examination for endometrial cancer is to assess the tumor's size, depth of invasion into the myometrium, invasion of the cervix, and spread outside the uterus, primarily to the pelvic and paraaortic lymph nodes. 

The evaluation should identify the patients to be offered more comprehensive surgery than a hysterectomy. The treatment schedule must be determined and also if a referral to a gynecological oncology department is necessary. Patients needing only hysterectomy and bilateral salpingo-oophorectomy can have the surgery performed at their local hospital, while patients requiring more comprehensive surgery are referred to gynecologic oncology centers for treatment.

 

Endometrial tumor in the uterine fundus and a small myoma.
Tumor showing less contrast absorption than the surrounding normal myometrium.
In part cystic and in part solid/recurrent tumor from uterine cancer.
Corresponding recurrent tumor posterior in the pelvis with close relation to the rectum.
Filling of lung artery from the right lower lobe causing a contrast defect in the vessel. This finding is consistent with a lung embolism as a complication of uterine cancer.
Large, mucinous tumor distending into the uterine cavity, filling the vaginal lumen and protruding from the vaginal opening.

Recurrence

About 70% of recurrences occur within 3 years after primary treatment. 

Examinations

  • Chest X-ray
  • CT abdomen/pelvis
  • Bone scintigraphy, if necessary 
  • PET-CT, if necessary

The most common localizations of recurrence are:

  • pelvis
  • upper abdomen
  • lungs
  • liver
  • bone
  • brain (rare)

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