Case Study: Ms. Wang, 53, works in management at a company. She maintains a polished appearance, often receiving compliments from colleagues and friends about her youthful look. Many first-time clients estimate her age to be only in her 40s. Yet, time has left its mark: Ms. Wang experienced natural menopause three years ago and navigated the transition smoothly.Three months ago, Ms. Wang suddenly experienced light vaginal bleeding that lasted four days before stopping naturally. She felt it resembled her previous menstrual sensations.
"Could I really be getting younger and menstruating again?" Ms. Wang felt both puzzled and concerned, prompting her to visit a gynecologist. After reviewing her symptoms, the doctor ordered a pelvic ultrasound. Results showed a 12mm endometrial lining with uneven echogenicity.Subsequently, the doctor performed a hysteroscopic segmental curettage. The postoperative pathology results revealed endometrial cancer.
Endometrial Cancer Incidence Rises Annually with Increasingly Younger Patients
Endometrial cancer is one of the three major malignant tumors of the female reproductive tract. In recent years, its incidence and mortality rates have gradually increased, with patients tending to be younger.In developed regions like Europe and the United States, it has surged to become the most common gynecological malignancy, accounting for 7% of all female cancers and 20-30% of female reproductive tract cancers. In 2015, the United States reported approximately 54,870 new cases of endometrial cancer and 10,170 deaths.In China, its incidence also shows a year-on-year upward trend. In some regions (Beijing, Shanghai, Zhongshan City), it has surpassed cervical cancer to become the leading gynecological malignancy.
The etiology of endometrial cancer remains unclear. Research indicates that hypertension, obesity, diabetes, estrogen replacement therapy, early menarche, delayed menopause, infertility, and tamoxifen use are all risk factors for endometrial cancer.
Common diagnostic methods for endometrial cancer: Ultrasound examination
Transvaginal ultrasound provides valuable information regarding endometrial cancer, including the size and location of the intrauterine mass, the degree of myometrial invasion, whether the tumor has penetrated the uterine serosa, and whether the cervical canal is involved. Its diagnostic concordance rate ranges from 79.3% to 81.82%.Reports indicate that in patients over 45 years old, ultrasound accuracy reaches approximately 87% when compared with hysteroscopic examination and biopsy.
Additionally, Xie Yanggui et al. used ultrasound in conjunction with UICC staging criteria, considering tumor location, myometrial invasion, and involvement of adnexal or adjacent organs. When compared with surgical exploration and pathology, their staging agreement rate reached 92.9%.Ultrasound is non-invasive and free of radiation exposure, making it a standard diagnostic tool for endometrial cancer. It holds particular value in assessing myometrial invasion and clinical staging.
Surgical Treatment for Endometrial Cancer
Indications: Fibroids equivalent to a uterus at 1.5 months of pregnancy or larger. Additionally, surgical removal is indicated for rapidly growing fibroids, those protruding into the abdominal cavity, or those with a tendency to twist. Other indications for surgery include severe anemia, cardiac disease, and overall systemic condition.
1. Hysterectomy
Indications: Large fibroids, severe symptoms, failure of conservative treatment, or suspected malignancy.
Advantages: Complete removal of the uterus eliminates symptoms.
Disadvantages: Permanent infertility and cessation of menstruation. 34% of women experience ovarian failure and menopausal symptoms within 2 years post-surgery.Hysterectomy compromises pelvic floor integrity, shortens the vagina, and may affect sexual function. Post-hysterectomy ovarian insufficiency reduces estrogen levels, increasing cardiovascular disease risk and predisposing patients to adverse effects like obesity, hypertension, heart disease, and osteoporosis. Patients require a 4-8 week recovery period.
2. Laparoscopic/Hysteroscopic Myomectomy
Advantages:Minimal incisions reduce pelvic adhesions; rapid recovery allows most patients to walk and eat by the afternoon of surgery; minimal wound pain and postoperative fever rarely require sedatives or analgesics; small incisions offer cosmetic appeal, aligning with younger patients' aesthetic preferences; shortened hospital stay typically permits discharge within 48 hours post-surgery.