Diagnosis

The first consultation is an important time.

It helps to guide the diagnosis by confirming the enduterine origin of the bleeding, prepares or takes the sample that will confirm the diagnosis and analyzes the general condition of the patient.

It is important to take stock of the general condition, with
- Age
   o and frailty research + / - onco-geriatrics consultation
   o or vice versa discussion of fertility preservation in the rare cases occurring in young women
- The search for obesity, the evaluation of its severity, the verification (or organization) of its management
- The search for high blood pressure and diabetes, the evaluation of its severity, the verification (or organization) of its management
- The search for other associated pathologies
- Identification of previous abdominal or pelvic interventions
- Search for personal and family history that may suggest Lynch syndrome (see specific tab)

The clinical examination is important since it verifies that the bleeding is of uterine origin, eliminating bleeding from the cervix, vagina or vulva.
It is possible to take an endometrial sample (endometrial biopsy) using a small cannula, in consultation.

The gynecological examination verifies that the tumor is “clinically” limited to the uterine body (the most common situation).
The abdominal examination verifies the absence of extension of the cancer.

It is also necessary to verify (or request) the realization of a mammogram and a cervical smear of screening if the age of the patient places her in the target population of the screening.
We also ask to stop any hormonal treatment.

It is important that this first consultation be carried out by a practitioner familiar with the pathology in order to gather all the important information from the outset and prescribe the right assessment from the outset.

Unless there is an ectopic anomaly noted by clinical examination, the only additional examination to be performed is a pelvic ultrasound.

This is a triage examination to distinguish women with a low risk of having a pathology from those who need to be explored further.

She is asked to measure the thickness of the endometrium.

The risk of secondarily diagnosing an endometrial or uterine cavity pathology is correlated to this thickness.
In premenopausal women, this thickness must be less than 8mm in the first part of the cycle and 10mm in the second part.
In premenopausal women, without hormonal treatment, the thickness should not exceed 6mm.

If the thickness is below the threshold, the risk of pathology is low. The bleeding is probably due to atrophy of the endometrium (mucosa that is too thin).

If the thickness is above the threshold, there is probably a pathology of the endometrium or of the uterine cavity and a second-line examination should be considered: diagnostic hysteroscopy and endometrial biopsy. It is useful to remember that in postmenopausal women, without hormonal treatment, the risk of diagnosing endometrial cancer following bleeding is less than 10%.

The other examinations are logically only requested in a second step, even if often the high probability of the diagnosis of endometrial cancer makes their prescription anticipated.

- Diagnostic hysteroscopy.
This examination consists of the introduction of a small diameter optical device (generally 3mm) into the uterine cavity, following the canal of the cervix.
Diagnostic hysteroscopy can be performed in consultation most often (with a medicinal preparation of the cervix to facilitate permeability). Otherwise, it is performed under anesthesia during outpatient hospitalization, especially when the cervix is ​​not very permeable.
We can thus observe the contents of the cavity and identify a polyp, a fibroid, suspicious vegetation.
Finally, hysteroscopy guides the performance of the endometrial biopsy.

- A tissue sample (biopsy)
Most often it is an endometrial biopsy performed during the initial consultation or immediately following the hysteroscopy.
More rarely, a curettage is performed.

This levy
- gives the diagnosis: endometrial adenocarcinoma;
- and provides all the important information to decide on the necessary assessment and the start of treatment: histological type, grade if applicable.
The quality of this diagnosis is important because it determines the very beginning of treatment.