I. Diagnostic points
(A) Clinical manifestations
Vaginal bleeding (postmenopausal: vaginal bleeding after menopause; non-menopausal: increased menstrual flow, prolonged menstrual period or intermenstrual bleeding), vaginal discharge (plasma or plasma blood), pain.
(II) Physical signs
Early stage: no obvious abnormalities; progressive stage : uterus enlargement;
Late stage: the uterus is obviously enlarged, occasionally cancerous tissues are seen to be prolapsed from the uterine orifice, brittle and bleeding easily when touched.
(III) Laboratory tests
Blood routine, liver and kidney function, urine routine, stool routine, CEA, CA125.
(IV) Cytological examination
Including routine cervical smear, uterine cavity and posterior fornix aspiration and vaginal wall smear.
(V) Histological examination
Staged scraping of the endometrium, with endocervical tissue scraped first, followed by endometrial tissue.
(F) Pelvic ultrasound, CT, MRI examination
They are of reference value in determining the size of the uterus, endometrium, cavity, myometrium and lymph nodes, thus helping in the formulation of the treatment plan.
(VII) Others
Including X-ray examination, intravenous pyelogram, cystoscopy, rectal, bone scan. Estrogen and progesterone receptor examination has some significance for endocrine treatment and estimation of prognosis.
II. Staging
Clinical staging (FIGO 1971)
Stage 0 Atypical hyperplasia, carcinoma in situ, and histological suspicion of carcinoma.
Stage I Carcinoma confined to the uterine body
Stage IA Uterine cavity depth of 8 cm or less
Stage IB depth of the uterine cavity greater than 8 cm
Stage II Cancer involving the uterine cervix
Stage III Cancer has spread beyond the uterine body but not beyond the true pelvis (vaginal and nest metastases are considered stage III)
Stage IV Cancer spreads outside the true pelvis or obviously invades the bladder and rectal mucosa. Vesicular edema does not belong to stage IV
Stage ⅣA organs, such as bladder, rectum, sigmoid colon, small intestine
Stage IVB Spread to distant organs
Surgical-pathological staging (FIGO, 2000)
Stage I Cancer confined to the uterine body
ⅠA Cancer confined to the endometrium
ⅠB Invasion of myometrium ≤1/2
ⅠC Invasion of myometrium >1/2
Stage II Cancer spreads to the cervix but not beyond the uterus
ⅡA Involving only the cervical duct glands
IIB Infiltrating the interstitial cervical space
Stage III Cancer confined to the pelvis or (and) regional metastasis
IIIA Cancer infiltrates into the plasma membrane and/or adnexa, or the ascites contains cancer cells, or the abdominal washout is positive
ⅢB Cancer spreads to the vagina
IIIC Cancer metastasis to pelvis and/or para-aortic lymph nodes
Stage IV Cancer infiltrating bladder mucosa or rectal mucosa or distant metastasis
ⅣA Cancer infiltrating bladder mucosa or rectal mucosa
IVB distant metastasis (excluding vaginal, pelvic mucosa, adnexal and para-aortic lymph nodes, but including other intra-abdominal lymph node metastasis)
Surgical staging is used only in cases initially treated surgically, and measurement of the depth of myxomatous invasion should be done simultaneously with myxomatous thickness. For cases treated with preoperative radiotherapy or pure radiotherapy, the 1971 clinical staging is still used.