Retrograde Seeding of Endometrial Cancer During Hysteroscopy

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What is Endometrial Cancer?

Endometrial cancer is a malignancy that occurs in the tissues lining the uterus or the endometrium. It is one of the most common type of cancer that develops in the uterus. The definite cause of the malignancy is unknown although medical experts associate it to the level of estrogen in the body. The hormone estrogen is responsible in stimulating the multiplication of cells present in the endometrium.

Factors that increases the risk of a woman in developing endometrial cancer includes infrequent menstruation, estrogen replacement therapy, diabetes, history of benign growths in the endometrium, nulliparity, infertility, obesity, Tamoxifen intake, polycystic ovarian syndrome, early menarche and early menopause.

Diagnosis of endometrial cancer can be done by taking a biopsy of the endometrium, by doing a dilatation and curettage procedure, or through a hysterectomy procedure. Dilatation and curettage is done by making the cervical opening wide and then removing contents of the uterus by scraping. An endometrial biopsy is usually done by taking a few tissue samples in the endometrium. Tissues are then sent to the laboratory for examination.

What is Hysterectomy?

Hysterectomy is a surgical procedure where the uterus is removed. Indications for this procedure include uterine fibroids, abnormal vaginal bleeding, cervical hyperplasia, prolapsed uterus and endometriosis. More serious conditions that require hysterectomy are cancers of the endometrium, cervix and ovaries.

The procedure is generally done under general anesthesia. There are three types of hysterectomy and these are total, subtotal and radical hysterectomy. The surgical procedure can be done vaginally, laparoscopically or abdominally.In total hysterectomy, the uterus as well as the cervix are removed. This is often performed in patients with uterine cancer or cervical cancer. In subtotal hysterectomy, only the uterus is being removed. And in a radical hysterectomy, the uterus, cervix and other parts of the female reproductive tract are also removed, such as the fallopian tubes, lymph nodes and ovaries. This procedure is frequently performed on women whose cancer has spread to the cervix.

How Does Retrograde Seeding Occur?

It has been documented that manipulation of uterine contents can lead to the spread of cancer cells into the peritoneal cavity. Because cells are being disturbed during the removal of endometrial contents, they can spill into the abdominal area during surgical procedures like laparoscopic hysterectomy, hysteroscopy, dilatation and curettage procedures, and during a hysterectomy. Hysteroscopy is another way of looking inside the uterus through the use of a scope passed through the vaginal canal in order to visualize for presence of abnormalities or for treatment of uterine abnormalities.

A study done in 2005, indicated that there is increased seeding of endometrial cancer during a dilatation and curettage procedure compared to a hysterectomy procedure. A 2009 study also revealed that there is no evidence that diagnostic laparoscopy may increase the seeding of cancer cells in the peritoneal cavity.

References: Uterine Cancer

Science Direct: The Roles of Endoscopy in Endometrial Cancer