Postablation Endometrial Carcinoma

Abstract

Background:Many women have undergone both resectoscopic and nonresectoscopic (or global) endometrial ablation (EA) during the past 20 years. These women are now approaching their sixth and seventh decades of life, a time frame in which endometrial carcinoma (EC) is most frequently diagnosed.Database:In several reports, surgeons have expressed concern that endometrial ablation may leave a sequestered island of EC that may escape detection, possibly delaying its diagnosis or causing it to appear at an advanced stage. Others suggest that EA artifact does not hinder the evaluation and treatment planning in the presence of EC. Data bases used are from Medline and PubMed.Discussion:We introduce 6 new cases of postablation endometrial carcinoma (PAEC), 4 of which occurred after the introduction of global endometrial ablation (GEA) techniques. In addition, we examine several key questions regarding the impact of EA on the subsequent development of EC, including the manner in which PAEC presents, the efficacy of traditional diagnostic modalities, the ablation-to-cancer interval, and the stage of PAEC at the time of diagnosis. Finally, we explore the use of reoperative hysteroscopic surgery (RHS) as a diagnostic modality and address the possible role ultrasound surveillance as a screening method for women at risk of EC.

Endometrial cancer after endometrial ablation or resection for menorrhagia

“…It has been reported that EA/R could affect the clinical presentation of endometrial cancer, and that women with endometrial cancer present with pelvic pain, new‐onset vaginal bleeding, or both . However, some patients could be entirely asymptomatic .…”

“…It has been reported that EA/R could affect the clinical presentation of endometrial cancer, and that women with endometrial cancer present with pelvic pain, new‐onset vaginal bleeding, or both . However, some patients could be entirely asymptomatic . Regenerating endometrium persists after EA/R; therefore, it is possible that a diagnosis of endometrial cancer could be missed after EA/R because the symptoms of abnormal uterine bleeding might not manifest until the malignancy has reached its advanced stage owing to post‐EA/R scarring of the uterine cavity .…”

“…By contrast, other studies have concluded that EA/R neither increases the risk of endometrial nor prevents early diagnosis owing to masking of symptoms or technical difficulties associated with performing hysteroscopy and biopsy. 2,[9][10][11][12] A literature search of publications in the English language identified 17 reported cases of endometrial after EA/R with adequate data on clinical and demographic characteristics 5,[21][22][23][24][25][26][27][28][29][30][31] (Table 2). However, F I G U R E 1 Rate of uterine corpus cancer stratified age group in Scotland.…”

“…31 However, some patients could be entirely asymptomatic. 31 Regenerating endometrium persists after EA/R 5 ; therefore, it is possible that a diagnosis of endometrial cancer could be missed after EA/R because the symptoms of abnormal uterine bleeding might not manifest until the malignancy has reached its advanced stage owing to post-EA/R scarring of the uterine cavity. 26 In the present study, however, the two patients with endometrial cancer were diagnosed at stage IA and there was no evidence Thus, the present cohort is likely to give an accurate assessment of the risk of endometrial cancer because the majority of the women have reached the plateau of the peak incidence of endometrial cancer in northeast Scotland.…”

“…A literature search of publications in the English language identified 17 reported cases of endometrial after EA/R with adequate data on clinical and demographic characteristics (Table ). However, most cases had simple, complex, or atypical endometrial hyperplasia on histopathology examination before EA/R; arguably, many of these women should not have been considered suitable candidates for EA/R.…”