Diagnosis of endometrial cancer.

Screening and initial diagnosis of endometrial cancer can be accomplished by cytologic or histologic sampling techniques when these are positive for malignant cells. When they are negative, the evaluation of the symptomatic patient requires further diagnostic procedures. Fractional dilatation and curettage remains the most reliable method and can begin to establish extent of disease. When dilatation and curettage results are negative in the symptomatic patient, hysterography or hysteroscopy can help identify lesions missed by curettage. Once the diagnosis has been established, a careful search for metastatic disease begins with careful pelvic examination and chest X-ray. When the endocervical curettage contains tumor cells, tracheloscopy and contact hysteroscopy can identify those patients with true endocervical involvement. Preoperative computed axial tomography (CT) or magnetic resonance imaging can direct a thin needle biopsy to prove metastatic disease when enlarged nodes are seen. These imaging techniques can also identify and localize highly suspicious nodes to be biopsied at surgery. Because of a high rate of false negativity, neither of these imaging techniques can exclude the presence of metastatic disease. If CT scanning is done, liver-spleen scan and intravenous pyelography may not be necessary as additional studies. In the absence of CT scanning, intravenous pyelography should be done as a routine, and liver-spleen scanning if liver function tests or physical examination indicate abnormalities. Magnetic resonance imaging and isotope scanning may be useful in the future but are not readily available yet. Surgical evaluation must include removal of the uterus, tubes and ovaries, sampling of the pelvic and para-aortic lymph nodes, and cytology on washings of the pelvic cavity for determination of the extent of disease and of factors placing the patient at high risk for disseminated metastases. Histopathologic evaluation of depth of myometrial invasion, presence of occult cervical involvement and lymph node metastasis and grade of tumor complete the identification of high-risk disease. Speedy and accurate evaluation and diagnosis of endometrial carcinoma and extent of disease can direct timely treatment and offer the patient the best chance for survival.