Unexpected Uterine Cancer Following Hysterectomy without Prior Evaluation versus Endometrial Evaluation: A Retrospective Study

Open Access

Abstract

Background: Uterine cancer (UC) is rising in low-resource settings. Despite advancements in diagnostic technology, many UC cases are diagnosed incidentally post-hysterectomy, complicating management and outcomes. This study aimed to compare the clinicopathological profile, treatment patterns, treatment completion, and 3-year oncological outcomes of the two groups of women diagnosed. Methods & Materials: This retrospective comparative study was carried out at the National Institute of Cancer Research and Hospital (NICRH), Bangladesh, between September 2018 and August 2019. The 57 women with histopathologically confirmed uterine cancer were divided into two groups: Group A (23 women) were diagnosed with uterine cancer before the hysterectomy through endometrial evaluation, and Group B (34 women) were diagnosed with uterine cancer unexpectedly after hysterectomy without prior evaluation of the endometrium. The demographic, clinical, histopathological, treatment, and 3-year survival data were compared between the two groups using SPSS version 26. Results: The mean age was 56.94 ± 4.62 years in Group A and 52.38 ± 9.46 years in Group B. Postmenopausal bleeding was the commonest presenting symptom in both groups (65.2% vs 67.6%). Most of the patients in Group B (70.6%) received adjuvant radiotherapy/chemotherapy alone, while all patients in Group A underwent staging laparotomy, and high-grade tumours (34.8% vs 14.7%) and non-endometrioid histology (30.4% vs 11.8%) were more common in Group A. The completion of treatment was significantly higher in Group A (87.0%) compared to Group B (52.9%) (p=0.008), and there was no significant difference between the groups in terms of follow-up regularity (p=0.653). Overall, 10.5% of participants experienced a recurrence at 3 years, with a slightly higher rate in Group B (12% vs 9%). Conclusions: Preoperative diagnosis via endometrial assessment facilitated targeted oncological therapy and considerably increased treatment completion rates. Although the three-year survival rates were comparable, the findings suggest that proper endometrial examination before hysterectomy is necessary for timely identification and coordinated therapy.