Endometrial Cancer Diagnosed in Patients Undergoing Hysterectomy for Benign Gynecologic Conditions

Objective To analyze the events preceding incomplete surgical staging procedures in endometrial cancer patients. Design Retrospective descriptive study Setting Department of Obstetrics & Gynecology, Faculty of Medicine, Chiang Mai University Subjects Thirty patients who were unexpectedly found to have endometrial cancer after undergoing hysterectomy for benign conditions and were referred to Chiang Mai University Hospital between January 1993 to December 1999. Results Nineteen patients (63%) presented with abnormal uterine bleeding, but only 9 had undergone fractional uterine curettage. The pre-operative pathological reports in 8 patients were endometrial hyperplasia,(5) proliferative endometrium,(1) chronic endocervicitis,(1) and endometrial polyps.(1) The remaining one patient underwent an emergency hysterectomy for severe uterine bleeding following fractional curettage. Eleven patients presented with symptoms other than bleeding, i.e. pelvic mass(6) pelvic pain,(3) vaginal discharge,(1) and uterine prolapse.(1) Ten of the 30 operations were performed for myoma uteri. The preoperative diagnoses of the remaining 20 patients were abnormal uterine bleeding,(5) endometrial hyperplasia,(5) ovarian tumor,(4) pelvic mass,(3) intractable vaginal discharge,(1) uterine prolapse,(1) and endometrial polyps.(1) Subsequent pathologic evaluation revealed gross appearance of endometrial cancer in the hysterectomy specimens of these patients. Conclusion Endometrial cancer might be detected in women undergoing hysterectomy for benign conditions. This situation is best prevented by careful evaluation of patients with abnormal uterine bleeding before definitive surgery. During curettage, the entire endometrium must be removed for accurate pathologic diagnosis. Routine intra-operative opening of the hysterectomy specimen is advised to detect any evidence of endometrial cancer.