For medical professionals only
Be wary of this kind of "irregular menstruation"
Recently, due to the epidemic, it is inconvenient to seek medical treatment, and the number of outpatients has suddenly decreased. However, I have received several patients in a row within a week who have come to see "menstrual irregularities".
Some of these patients are perimenopausal women, some menstruation does not last for many months, some menstruation goes away for a few days and comes, and some are menopausal women who have been menopausal for many years and suddenly have abnormal vaginal bleeding.
They don't pay much attention to it, and generally take some hemostatic drugs on their own. Unexpectedly, the effect was not good, and even led to anemia, and some of them fainted from heavy bleeding.
Case 1
Sun Mou, 46 years old, has rare menstruation in the past 2 years, increased menstrual volume, blood clots, intermittent oral Chinese medicine conditioning, and the effect is not good. Before admission, the vagina bled for more than 20 days, and came to the hospital for examination. Color ultrasound examination tips: intrauterine cavity probing and uneven echoes ranging from about 4.2 cm × 3.3 cm × 1 .6cm.
Hysteroscopy + curettage, pathological prompts: complex atypical hyperplasia of the endometrium, partially consistent with highly differentiated endometrioid carcinoma.
Case 2
Wang Mou, 58 years old, menopause for 3 years, began to have a small amount of vaginal bleeding without obvious cause half a year ago, and was not diagnosed and treated. In 1 month, the amount of vaginal bleeding increased compared with before, there were blood clots, and the self-administered oral hemostasis drugs were not good. Color ultrasound examination reveals intrauterine cavity probing and an uneven echo with a range of about 5.2 cm×3.8cm×3 .8cm.
Hysteroscopy + curettage, pathological prompt: tendency to highly differentiated endometrioid carcinoma.
Case three
Wang Mou, 47 years old, intermenstrual bleeding for 1 year, did not standardize treatment, had a local outpatient curettage to stop bleeding twice, but scraped out the tissue did not send pathological results. Half a month ago, vaginal bleeding increased again, accompanied by lower abdominal pain to the hospital for examination. Color ultrasound tips: a stripe of uneven echo of about 1.7 cm in the uterine cavity, an introspection of the right ovary and a cystic echo of about 5.0 cm in size× 3.7 cm × 3.5 cm.
Postoperative pathological prompts: uterine-endometrioid adenocarcinoma; right-sided attachment-metastatic endometrioid adenocarcinoma.
Case FOUR
Ji Mou, 71 years old, 20 years after menopause, vaginal irregular bleeding for 3 days. Color ultrasound tip: uterine cavity internal probing and range of about 4.4 cm× 3.0 cm× 3.1 cm mixed echo, full of uterine cavity, unclear boundaries, and muscle layers are not clear.
Post-curettage pathology: endometrial cancer.
Case 5
Chen Mou, 74 years old, menopause for 22 years, vaginal bleeding twice. Color ultrasound tip: the lower and middle segment of the uterine cavity probes and ranges from a slightly stronger uneven echo of about 2.9 cm× 2.2 cm × 2.7 cm.
Post-curettage pathology: carcinoma with low differentiation of the endometrium.
Seeing this, everyone felt frightened and nervous.
At present, the public's understanding of cervical cancer is more common, and the understanding of endometrial cancer is still insufficient.
In fact, endometrial cancer ranks second in China for malignant tumors of the female reproductive system and first in developed countries. According to the statistics of the National Cancer Center in 2019, the incidence rate of endometrial cancer in China is 10.28/100,000, and the mortality rate is 1.9/100,000, and the data is still shocking.
01
What is endometrial cancer associated with?
Obesity, diabetes, and hypertension are known as the triad of endometrial cancer. Studies have shown that for every 1 increase in body mass index (BMI), the risk of endometrial cancer increases by 9%. The risk of diabetes is 2.8 times higher than that of normal people, and the risk of hypertension is 1.8 times higher.
In addition, endometrial cancer is also associated with the following factors:
Persistent estrogen exposure, such as estrogen replacement without progesterone alone
Breast cancer survivors use tamoxifen;
Carrying genetic predisposing genes for endometrial cancer, such as Lynch syndrome;
Early menarche (≤12 years old), late menopause (≥ 55 years old);
Infertility;
eld.
Combined with the above five cases, it can be seen that they have high risk factors, and because of the epidemic, they chose to take hemostatic drugs at home first, most of which contain estrogen and progesterone, which increases the risk of cancer.
02
What are the symptoms of endometrial cancer?
▌ Irregular vaginal bleeding and drainage
About 90% of patients with endometrial cancer have symptoms of irregular vaginal bleeding, usually after menopause. Some present with abnormal vaginal discharge, which may be serous or bloody discharge. Perimenopausal patients may present with increased menstrual volume, prolonged menstrual periods, inexhaustible menstruation, and intermenstrual bleeding.
▌ Uterus enlargement, pain
Most endometrial cancers are diagnosed early and often do not show uterine enlargement during physical examination, but if the tumor invades the inner opening of the cervix, resulting in blood or pus in the uterine cavity, it can cause lower abdominal distention and spastic pain. In advanced patients, tumor invasion of surrounding tissues or nerves can cause pain in the lower abdomen or lumbosacral region.
03
If the above symptoms occur,
How can I determine if I have endometrial lesions?
1. Endometrial biopsy.
If these symptoms are present and endometrial lesions are highly suspected, endometrial biopsy should be performed to confirm the diagnosis. Including: endometrial aspiration biopsy, diagnostic curettage, hysteroscopic diagnostic curettage, etc., histopathological examination can confirm the diagnosis.
2. Imaging examination.
Ultrasonography, pelvic-abdominal enhanced MRI, or enhanced CT, and systemic PET/CT may be performed if there is suspected metastasis.
3. Tumor marker detection.
At present, there are no specific and sensitive tumor markers available for the diagnosis and follow-up of endometrial cancer. In patients with extrauterine lesions, glycoantigen 125 (CA125) helps monitor clinical response. However, in the absence of other clinical manifestations, CA125 cannot accurately predict recurrence.
Human epididymides protein 4 (HE4) may have some reference value for the diagnosis and prognosis of patients with endometrial cancer.
Once it is determined that endometrial cancer is determined, the treatment method is mainly surgery, and radiotherapy and chemotherapy are adjuvant. Comprehensive treatment based on the patient's individual situation.
04
Did not present with the above symptoms,
How can it be prevented?
Women who do not have the above symptoms are recommended to undergo regular physical examinations, especially women ≥ 50 years of age to screen for endometrial cancer every year, the main way is transvaginal ultrasonography (monitoring the thickness of the endometrium, whether there are abnormal blood flow signals, etc., for postmenopausal women, the thickness of the endometrium under ultrasound ≤ 4 mm, the negative predictive value of endometrial cancer >99%), endometrial microhistological examination and endometrial cytology.
Women < 50 years of age, but who meet the following conditions, it is recommended to decide whether to screen according to the judgment of a doctor.
Abnormal vaginal bleeding, especially after menopause.
Over 35 years of age carry genetic predisposition or family history of endometrial cancer (especially breast, colorectal, and female reproductive tumors).
> 30 years old and obese (BMI≥28 kg/m2), diabetes and high blood pressure.
There are ovulation disorders, such as polycystic ovary syndrome, infertility, etc.
Although 70% to 75% of endometrial cancer patients are postmenopausal women, with an average age of about 55 years old, endometrial cancer has shown a younger trend in recent years due to factors such as high-oil and high-sugar diet, irregular work and rest.
When relevant symptoms are found, be sure to go to a regular hospital for a systematic examination in time to avoid taking medication by yourself so as not to delay the condition.
bibliography:
Gynecologic Oncology Committee of Chinese Anti-Cancer Association. Guidelines for the diagnosis and treatment of endometrial cancer (2021 edition)[J].Chinese Journal of Oncology,2021,31(06):501-512.
[2] Yu Mei,Xiang Yang,Ma Xiaoxin,et al. Recommendations on screening norms for endometrial cancer[J].Chinese Journal of Obstetrics and Gynecology, 2020(05):307-311.
Jin Bixia, Kong Weimin. Interpretation of the International Federation of Obstetrics and Gynecology (FIGO) 2018 Cancer Report: Guidelines for the Diagnosis and Treatment of Endometrial Cancer[J]. Chinese Journal of Clinicians, 2019, 47(10):4.
This article was first published: Medical Sciences Obstetrics and Gynecology Channel
This article is written by Guo Dongxia
This article is reviewed: Gu Zhuowei
Editor-in-Charge: Ichikawa
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