When does endometrial cancer require surgery?

The occurrence of endometrial cancer poses a great threat to the patient's uterine health and requires acute, timely and reasonable treatment. If the tumor of an endometrial cancer patient is smaller than three centimeters and has not metastasized, it can be removed surgically. When it comes to choosing treatment, patients should follow their doctor's advice and make the best choice.

There are no obvious symptoms in the very early stages of endometrial cancer, but vaginal bleeding, vaginal discharge, and pain may occur later. The early symptoms of endometrial cancer mainly include the following:

1. Lower abdominal pain and others: If the cancer involves the internal cervical os, it can cause pyometra, lower abdominal distension and cramp-like pain. In the late stage, it can infiltrate surrounding tissues or compress nerves, causing pain in the lower abdomen and lumbosacral region.

2. Vaginal discharge: mostly bloody or serous secretions. If combined with infection, there will be purulent and bloody discharge with a foul odor. About 25% of patients seek medical treatment due to abnormal vaginal discharge.

3. Vaginal bleeding: It mainly manifests as vaginal bleeding after menopause, and the amount is generally not much. Women who have not yet reached menopause may experience increased menstruation, prolonged menstruation, or menstrual disorders.

Most endometrial cancers grow slowly and are confined to the endometrium for a long time. The main metastatic routes are direct spread and lymph node metastasis, and hematogenous metastasis may occur in the late stage. If the tumor of endometrial cancer is smaller than three centimeters and has not metastasized, it can be removed surgically. However, since the cancer's encirclement is destroyed, it is easy to stimulate metastasis. After removal, no radiotherapy or chemotherapy is performed. If it recurs, it can be removed again.

Based on the above symptoms, auxiliary examinations can usually confirm whether it is endometrial cancer. Therefore, women should always pay attention to changes in their menstruation and the nature of vaginal secretions; once symptoms appear, go to the hospital for examination as soon as possible.

Surgical treatment of endometrial cancer:

Experts say that surgery for simple endometrial cancer is better than radiotherapy alone, with a cure rate 20% higher. Surgery can clarify the extent of the lesion and correctly perform clinical staging to determine the scope of surgery. Whenever surgery is possible, surgery should be performed first to remove the lesion as much as possible and reduce the size of the tumor. Radiotherapy or progestin treatment can be used after surgery. Otherwise, it is advisable to first use progesterone, radiotherapy and/or chemotherapy and then wait until surgery is possible. Surgical treatment of endometrial cancer still requires additional treatment.

(1) Ascites or peritoneal washings are used to search for cancer cells. After the peritoneum is opened, ascites is collected and centrifuged to precipitate the fluid to search for cancer cells. For patients without ascites, 200 ml of normal saline is injected into the peritoneal cavity to flush the peritoneal cavity, and the flushing fluid is aspirated and centrifuged to precipitate the cells to look for cancer cells. In addition to surgery, other auxiliary treatments should be given to those who find cancer cells.

(II) Determination of myometrial invasion during surgery: For stage I cancer in which the uterus is smaller than normal size and the patient has limited surgery time due to some reasons, the uterine adnexes can be performed first, and the uterine specimen can be dissected to determine whether there is myometrial invasion. Of course, sometimes the specimen is difficult to judge and subtle changes can be noticed under the microscope.

(III) Those who are not prepared for lymph node dissection: routinely explore the pelvic and abdominal para-aortic lymph nodes. Those with enlargement should at least undergo a biopsy. If the technical conditions are met and the patient allows, surgical lymph node dissection for endometrial cancer can be performed.