小结
定义
病史和体格检查
关键诊断因素
- 绝经后阴道出血 (PVB)
其他诊断因素
- 子宫包块、宫体固定或附件区包块均提示宫外转移。
- 绝经前女性月经异常或异常阴道出血
- 疼痛（腹部或盆腔）和体重减轻
- 转移性疾病的症状
- 转移性疾病的体征
危险因素
- 超重和肥胖
- 年龄>50 岁
- 子宫内膜增生
- 无拮抗的内源性雌激素
- 无拮抗的外源性雌激素
- 他莫昔芬治疗（绝经后女性）
- 胰岛素抵抗
- 子宫内膜癌或结直肠癌家族史
- 乳腺癌或卵巢癌家族史
- Lynch 综合征（遗传性非息肉病性结直肠癌）家族史
- PTEN 综合征家族史
- 多囊卵巢综合征
- 放射治疗
- 缺乏运动
- 饮食
- 未孕未产
诊断性检查
首要检查
- （经阴道）盆腔超声
- 门诊子宫内膜活检（伴或不伴门诊子宫切除术）和组织病理学检查
- 宫腔镜、诊断性刮宫 (D&C) 及组织病理学检查
- 宫颈细胞学检查（巴氏涂片或液基细胞学检查）
- 全血细胞计数 (FBC）
需考虑的检查
- 分子遗传学分析
- 血清 CA-125 水平
- 盐水灌注宫腔声学造影
- 尿素和肌酐（肾功能检测）
- 肝功能检查 (LFT)
- 胸部 X 线检查
- 胸部、腹部和盆腔 CT 扫描
- 子宫、盆腔及腹部 MRI 检查
- PET/CT 扫描
治疗流程
不考虑保存生育功能的 IA 期子宫内膜样癌
考虑保存生育功能的 IA 期子宫内膜样癌
IB 或 II 期子宫内膜样癌
III-IV 期子宫内膜样癌；所有非子宫内膜样癌（高风险）
复发或不能治愈的肿瘤
撰稿人
作者
Alexander B. Olawaiye, MD, MRCOG, FACOG, FACS
Associate Professor
Division of Gynecologic Oncology
Department of Obstetrics, Gynecology, and Reproductive Sciences
Magee-Womens Hospital of UPMC
University of Pittsburgh School of Medicine
Pittsburgh
PA
利益声明
ABO is on the scientific advisory board for AstraZeneca, GlaxoSmithKline, Clovis, and Genentech.
Richard T. Penson, MD, MRCP
Clinical Director
Medical Gynecologic Oncology
Division of Hematology Oncology
Massachusetts General Hospital
Boston
MA
利益声明
RTP declares that his institution has received research funding from Array BioPharma Inc., AstraZeneca, Genentech, and Vascular Biogenics Ltd on his behalf. RTP has received research funding from Genentech Inc., ImClone Systems Inc., Endocyte Inc., AstraZeneca, Eisai Inc., Amgen Inc., and Vascular Biogenics Ltd. He has been paid for participating in scientific advisory boards for AbbVie, AstraZeneca, Baxalta Oncology, Clovis Oncology, Curio Science, Eisai Inc., Endocyte Inc., Genentech, Janssen Oncology (J&J), Merck & Co., Mersana Therapeutics Inc., NewLink Genetics, Nexus Global Group, Pieris Pharma Inc., Roche Inc., Sutro Biopharma, Syndax Pharmaceuticals, Tesaro Inc., and Vascular Biogenics Ltd. RTP was an expert witness for Aventis Pharma S.A. vs. Apotex Inc. in 2009. RTP has received royalties from: BMJ, Blackwell Publishing Medicine at a glance, and UpToDate Advance Medical: Second Medical Opinion.
鸣谢
Dr Alexander B. Olawaiye and Dr Richard T. Penson would like to gratefully acknowledge Dr Larissa J. Lee, their co-contributor who has sadly died, and to acknowledge Dr Neil S. Horowitz and Dr Anthony H. Russell, previous contributors to this topic.
利益声明
NSH and AHR declare that they have no competing interests.
同行评议者
Susan A. Davidson, MD
Associate Professor/Chief
Gynecologic Oncology
S/M Obstetrics & Gynecology (UCD)
University of Colorado Health Sciences Center
Aurora
CO
利益声明
SAD declares that she has no competing interests.
Svetlana Mironov, MD
Attending Radiologist
Assistant Professor of Radiology
Memorial Sloan-Kettering Cancer Center
New York
NY
利益声明
SM declares that she has no competing interests.
鉴别诊断
- 子宫内膜增生
- 子宫内膜息肉
- 子宫内膜异位症
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