Diagnosis of endometrial cancer and its precursors

Abstract

Whereas cervical carcinoma is reliably detectable by the noninvasive methods of cytological/cervical smear and HPV typing even in the early stages, endometrial carcinoma thus far eludes effective check-up. Neither ultrasound nor invasive procedures such as Pipelle de Cornier, abrasio fracta or hysteroscopy, succeeded in making the majority of endometrial carcinomas detectable at an early stage in systematic screenings. Several factors contribute to this fact: first, only a fraction of these carcinomas develops through early stages of atypical hyperplasia, whereas the majority develops de novo. As the most suitable screening method in general, ultrasound fails in pre- and perimenopausal women, who account for 30% of new endometrial carcinoma cases. Moreover, patient compliance with preventive examinations is especially low in the high risk population of senior women. And, finally, there are issues regarding the clinical consequences of improved diagnosis, since endometrial carcinomas may become clinically significant in only 1 of every 4-6 patients, whereas the majority of these malignomas remains clinically inapparent. Hence, atypical uterine bleeding will continue to be the main symptom prompting hysteroscopic and histological clarification (H&H) and ensuing detection of endometrial carcinomas and their early stages.