Tumor Characteristic Variations between Symptomatic and Asymptomatic Endometrial Cancer.

Petra Vinklerová,Luboš Minář,Vít Weinberger,Michal Felsinger,Jitka Hausnerová,Markéta Bednaříková,Petra Ovesná

doi:10.3390/healthcare9070902

Petra Vinklerová, Luboš Minář + Show 5 more

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https://doi.org/10.3390/healthcare9070902

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Abstract

Endometrial cancer is the most common gynecologic malignancy in Europe and usually diagnosed in its initial stage owing to early symptoms of abnormal bleeding. There is no population screening for this disease, although it can sometimes be accidentally diagnosed in asymptomatic patients. Our study aims to determine differences in clinical and tumor characteristics between an asymptomatic and symptomatic group of patients. This unicentric prospective observational study took place in University Hospital Brno between January 2016 and December 2019. A total of 264 patients met inclusion criteria (26% asymptomatic, 74% with reported symptoms). We did not find a statistically significant difference in clinical characteristics (menopausal status, parity, age, BMI, and serum level of CA 125) between groups. According to ultrasound examination, bleeding tumors were larger (19.5 vs. 12.7 mm, p ≤ 0.001). Definitive histology results indicated more frequent lymphovascular space invasion (p < 0.001), along with deep myometrial (p = 0.001) and cervical (p = 0.002) invasion. There was no difference in advanced stages of the tumor. We did not substantiate statistically significant difference in immunohistochemical profile (estrogen and progesterone receptors, L1 cell adhesion molecule, tumor protein p53), which is relevant for tumor recurrence risk and survival capacity. Our conclusions affirmed that bleeding occurs more often among patients with local tumor invasion into the myometrium and cervical stroma. Final International Federation of Gynecology and Obstetrics (FIGO) stage, histology, and immunohistochemical characteristics do not significantly affect symptom appearance.

Highlights

Endometrial cancer (EC) is the most common gynecologic malignancy in Europe, and incidence is increasing [1]
The cancer can be unintentionally recognized among symptom-free women with thickened endometrium on an ultrasound scan or in a uterus specimen following a hysterectomy executed for other reasons
In many countries where ultrasound is routinely used in daily practice, ordering a biopsy with asymptomatic patients is common after recognizing specific abnormal ultrasound images

Summary

Introduction

Endometrial cancer (EC) is the most common gynecologic malignancy in Europe, and incidence is increasing [1] It is usually diagnosed in the first or second stage in accordance with The International Federation of Gynecology and Obstetrics (FIGO) 2009 classification. The cancer can be unintentionally recognized among symptom-free women with thickened endometrium on an ultrasound scan or in a uterus specimen following a hysterectomy executed for other reasons (uterine prolapse, uterine fibroids, etc.). Population screening for this cancer does not exist, and routine biopsy of the asymptomatic patient with endometrial polyps or thickened endometrium is not recommended [2,3]. Even women with no signs of bleeding can be diagnosed with incidental endometrial cancer

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