Štefan Lukačín, Martin Hoppan
Possibilities for screening and early diagnosis
Endometrial carcinoma is the most common female genital cancer. Obviously, the annual mortality rate is very high.
The Slovak Republic is among the countries with the highest prevalence and mortality. At this moment there is no an
efficient screening program and therefore the aim in our country is to improve the diagnostic process to identify and
treat the disease in initial stages.
To create the effective diagnostic process, it is important to know the risk factors and nature of the disease.
There are two types of endometrial cancer: Type 1 is estrogen-dependent, affecting premenopausal and postmenopausal
women, with good prognosis and covers 80% of the prevalence. Type 2 of endometrial carcinoma is non estrogen-
dependent and it can also affect the younger women in their pre-menopause. Its prognosis is much worse.
Long lasting exposition of estrogens without gestagen opposition is considered to be the most important risk factor.
A significant risk group is created by obese women, women suffering from diabetes, hypertension, Lynch syndrome,
women carrying the mutation of BRCA 1 gene and those undertaking the tamoxifen treatment.
The knowledge of these risk groups can focus the diagnostic efforts directly on women at a high risk of endometrial carcinoma.
Transvaginal ultrasonography (TVUSG) is a basic diagnostic procedure. A critical evaluation of basic standards
of a uterine cavity and endometrium imaging helps to distinguish a group of women who need an endometrial biopsy.
These parameters are evaluated during TVUSG: the thickness of the endometrium, its echogenity and midline, the presence
of intrauterine fluid, endometrium-myometrium junction and vascularization. Not only women with vaginal bleeding,
but also asymptomatic women are examined.
Fractional curettage is still a basic method for acquiring some representational material. However, hysteroscopy provides
significantly more information and it can improve our results especially if the endometrial lesion is focal. In some
cases it is more convenient to use less demanding methods for endometrial sampling e.g. flexible low-pressure cannula
Pipelle, non- flexible high-pressure cannula Vabra or Tao brush. No need for anesthesia is a big advantage of these
methods.