Zusammenfassung
Das Endometriumkarzinom ist mit einer Inzidenz von 28/100.000 Frauen pro Jahr das häufigste Genitalkarzinom der Frau. Da die Prognose dieser Erkrankung bei frühzeitiger Diagnose im Stadium I mit einer Fünfjahresüberlebensrate von 85 % gut ist, konzentrieren sich wie bei allen soliden Karzinomen die klinischen Bemühungen auch beim Endometriumkarzinom darauf, diese Erkrankung zu einem möglichst frühen Zeitpunkt zu erkennen und zu behandeln. In der klinischen Praxis erfolgt die Diagnose eines Endometriumkarzinoms in der Regel im Rahmen der weiteren Abklärung einer symptomatischen Patientin, die sich aufgrund von Blutungsstörungen, meist einer Blutung in der Postmenopause, oder auffälligem Ausfluss vorstellt. Im vorliegenden Beitrag werden die Verfahren, die zur Früherkennung eines Endometriumkarzinoms zur Verfügung stehen, vorgestellt und ihre Wertigkeit kritisch diskutiert.
Abstract
Endometrial cancer is the most common genital cancer in women with an annual incidence of 28 per 100,000 women. Because the prognosis of this disease is good by early recognition in stage I with a 5-year survival rate of 85 %, the clinical efforts with endometrial cancer as with all solid tumors are concentrated on recognizing and treating this disease as early as possible. In the clinical practice as a rule the diagnosis of endometrial cancer is made within the framework of a further clarification of symptomatic patients presenting mostly with postmenopausal bleeding disorders or a conspicuous discharge. This article describes the procedures available for early recognition of endometrial cancer and the significance is critically discussed.
Literatur
Astrup K, Olivarius NF (2004) Frequency of spontaneously occurring postmenopausal bleeding in the general population. Acta Obstet Gynecol Scand 83:203–207
Dijkhuizen FP, Brolmann HA, Potters AE et al (1996) The accuracy of transvaginal ultrasonography in the diagnosis of endometrial abnormalities. Obstet Gynecol 87:345–349
Dutch Society of Obstetrics and Gynecology (NVOG) (2003) Diagnostics in abnormal vaginal blood loss in the postmenopausal period. http://dare.nva.nl/document/488116
Feldman S, Berkowitz RS, Tosteson AN (1993) Cost-effectiveness of strategies to evaluate postmenopausal bleeding. Obstet Gynecol 81:968–975
Clark TJ, Mann CH, Shah N et al (2001) Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial hyperplasia. Acta Obstet Gynecol Scand 80:784–793
Bakkum-Gamez J, Dowdy S (2014) Retooling the pap smear for ovarian end endometrial cancer detection. Clin Chem 60:22–24
Van Doom HC, Opmeer BC, Kooi GS et al (2009) Value of cervical cytology in a diagnosing endometrial carcinoma in women with postmenopausal bleeding. Acta Cytol 53:277–282
Zhou J, Tomashefski JF Jr, Sawady J et al (2013) The diagnostic value of the ThinPrep pap test in endometrial carcinoma: a prospective study with histological follow-up. Diagn Cytopathol 41:408–412
Jacobs I, Gentry-Maharaj A, Burnell M et al (2011) Sensitivity of transvaginal ultrasound screening for endometrial cancer in postmenopausal women: a case-control study within the UKCTOCS cohort. Lancet Oncol 12:38–48
Gerber B, Krause A, Muller H et al (2001) Ultrasonographic detection of asymptomatic endometrial cancer in postmenopausal patients offers no prognostic advantage over symptomatic disease discovered by uterine bleeding. Eur J Cancer 37:64–71
Horwitz RI, Feinstein AR, Horwitz SM, Robboy SJ (1981) Necropsy diagnosis of endometrial cancer and detection-bias in case/control studies. Lancet 2:66–68
Organkommission Uterus der AGO (2013) Die interdisziplinäre S2k-Leitlinie für die Diagnostik und Therapie des Endometriumkarzinoms. http://www.ago.de
Schmidt T (2009) Hysteroscopy for asymptomatic postmenopausal women with sonographically thickened endometrium. Maturitas 62:176–178
Smith-Bindman R, Kerlikowske K, Feldstein VA et al (1998) Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. JAMA 280:1510–1517
Van Hanegem N (2011) Diagnostic evaluation of the endometrium in postmenopausal bleeding: an evidence-based approach. Maturitas 68:155–164
Lethaby A, Suckling J, Barlow D et al (2004) Hormone replacement therapy in postmenopausal women: endometrial hyperplasia and irregular bleeding. Cochrane Database Syst Rev CD000402 (Online)
Van den Bosch T, Van Schoubroeck D, Ameye L et al (2003) Ultrasound assessment of endometrial thickness and endometrial polyps in women on hormonal replacement therapy. Am J Obstet Gynecol 188:1249–1253
Dreisler E, Stampe Sorensen S, Ibsen PH, Lose G (2009) Prevalence of endometrial polyps and abnormal uterine bleeding in a Danish population aged 20–74 years. Ultrasound Obstet Gynecol 33:102–108
Ferrazzi E, Zupi E, Leone FP et al (2009) How often are endometrial polyps malignant in asymptomatic postmenopausal women? A multicenter study. Am J Obstet Gynecol 200:235 e1–e6
Lee SC, Kaunitz AM, Sanchez-Ramos L, Rhatigan RM (2010) The oncogenic potential of endometrial polyps: a systematic review and meta-analysis. Obstet Gynecol 116:1197–1205
Singh MN, Stringfellow HF, Paraskevaidis E et al (2007) Tamoxifen: important considerations of a multi-functional compound with organ-specific properties. Cancer Treat Rev 33:91–100
Gao W, Zhang LP, Feng LM (2011) Comparative study of transvaginal ultrasonographic and diagnostic hysteroscopic findings in postmenopausal breast cancer patients treated with tamoxifen. Chin Med J (Engl) 124:2335–2339
Bertelli G, Venturini M, Del Mastro L et al (1998) Tamoxifen and the endometrium: findings of pelvic ultrasound examination and endometrial biopsy in asymptomatic breast cancer patients. Breast Cancer Res Treat 47:41–46
Gerber B, Krause A, Müller H et al (2000) Effects of adjuvant tamoxifen on the endometrium in postmenopausal women with breast cancer: a prospective long-term study using transvaginal ultrasound. J Clin Oncol 18:3464–3470
Fung MF, Reid A, Faught W et al (2003) Prospective longitudinal study of ultrasound screening for endometrial abnormalities in women with breast cancer receiving tamoxifen. Gynecol Oncol 91:154–159
- Einhaltung ethischer Richtlinien
Interessenkonflikt. P. Mallmann gibt an, dass kein Interessenkonflikt besteht. Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethikkommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mallmann, P. Früherkennung des Endometriumkarzinoms. Gynäkologe 47, 340–345 (2014). https://doi.org/10.1007/s00129-013-3260-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00129-013-3260-5