PREOPERATIVE EVALUATION AND STAGING OF ENDOMETRIAL CANCER

Preoperative examination of a patient for whom a diagnosis of endometr ial cancer has been made by office biopsy or dilatation and curettage includes careful history taking and physical examination, with emphasi s on the pelvic examination, blood tests, and imaging evaluations of t he pelvis, abdomen and chest, and other specific studies related to me dical operability. The primary approach to endometrial cancer is surge ry, which has been used for staging and treatment since the adoption o f the Federation of Obstetrics and Gynecology system in 1988. Pilot st udies and the Gynecologic Oncology Group have researched this system e xtensively and have emphasized the findings that could be defined only by pathologic study of the uterus, adnexa, retroperitoneal lymph node s, and peritoneal cytologic findings. Preoperative endocervical evalua tion is no longer necessary unless gross invasion of the cervix is sus pected. However, initial histologic findings can identify patients at high risk, that is, those with high grade adenocarcinomas, clear cell carcinomas, adenosquamous carcinomas, and papillary serous adenocarcin omas. Intraoperative pathologic evaluation of the uterus by frozen sec tion, which reveals depth of invasion into the myometrium and correlat ion with tumor grade, can identify patients for whom lymph node sampli ng should be performed.