Endometrial Carcinoma Differential Diagnoses

Updated: Oct 05, 2017
  • Author: William T Creasman, MD; Chief Editor: Warner K Huh, MD  more...
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DDx

Diagnostic ConsiderationsImportant considerationsSpecial concerns

Bleeding from the lower genital tract can occur from the cervix, vulva, or vagina. If the bleeding is due to neoplasms, gross inspection usually helps identify these lesions. If cervical cytology findings are abnormal and no gross lesions are identified, further evaluation must be performed.

Atrophic changes in the vagina may lead to bleeding, particularly postcoital. Bleeding from the uterus may be due to any of the many types of benign lesions (eg, polyps, endometritis) or to hormone replacement therapy.

Ignored irregular postmenopausal bleeding could lead to a delay in diagnosis and treatment, which may impact survival.

Multiple new prognostic factors of endometrial cancer are being evaluated and are brought about by newer technology, which allows for molecular biological evaluation. Because these evaluations are new, no general agreement has been reached about their importance. Note the following:

  • Flow cytometry has been used in ploidy analysis (cellular nuclear DNA content) and to measure the proliferative fraction of tumor cells (S phase).
  • The prognostic factors of the endometrial cancer precursor 1 score (ie, myometrial invasion, DNA ploidy, and mean shortest nuclear axis) have been evaluated, and in at least one study, multivariant analysis was noted to be important prognostically.
  • Several other molecular biological characteristics have been noted to be important prognostically, including HER2/NEU and TP53 gene overexpression.
  • Newer characteristics are being identified almost daily. Obviously, the necessity for standardization is needed before applicability is available and conclusions can be reached. As experience is gained with these factors, they may be the new prognostic factors for endometrial cancer.

The use of pelvic and para-aortic lymphadenectomy in the management of adenocarcinoma of the endometrium is controversial, as follows:

  • Whether the procedure aids in diagnosis is not in doubt. The question that has been raised is whether or not it also might be therapeutic. It certainly appears to be therapeutic for other gynecological cancers. Retrospective data by Kilgore and colleagues suggest that lymphadenectomy in endometrial cancer can also be therapeutic. [9]
  • The number of lymph nodes removed appears therapeutic even if positive nodes are present. In evaluating the SEER data, Chan has noted that patients with positive lymph nodes but few total nodes removed had a worse prognosis than if multiple nodes were removed. [10]
  • When proposed, the FIGO surgical staging classification was questioned as being efficacious by many investigators. However, data suggest that the gynecologic oncology community worldwide has accepted the surgical staging classification. In fact, lymphadenectomies are being performed routinely by these investigators.