The operator should not be content with the removal of a few strips or portions of the endometrium. He should remember that in the early stages the disease may be confined to a small area, and, unless the whole interior of the uterus is gone over, this area may be missed by the curette, and only healthy endometrium may be removed for examination. Such thorough curetting is of especial importance in case the tissue removed should at first present no suspicious features upon gross examination. All portions of the endometrium should be saved and preserved as directed in cancer of the cervix.
The tissue should be submitted for examination to a person trained in gynecological pathology. The recognition of the early stages of cancer of the endometrium, and especially of malignant adenoma, requires the training of the expert. If a positive diagnosis cannot be given from the microscopic examination, the case should be carefully watched, and if the symptoms continue, subsequent curetting and microscopic examination should be made.
The treatment of cancer of the fundus is immediate complete hysterectomy, with removal of the tubes and ovaries. Cancer has recurred in an ovary after removal of the uterus. The hysterectomy may be performed by the vaginal, the abdominal, or the combined method.
The ultimate results of hysterectomy for cancer of the body of the uterus are exceedingly good. Statistics show about 75 per cent. of permanent cures. Recurrence may be considered exceptional. In this respect they are in marked contrast to the results after operation for cancer of the cervix.
SARCOMA OF THE UTERUS.
Sarcoma of the uterus is a very rare disease. There have been but few properly authenticated cases of this disease reported in medical literature. All cases of this disease should be put on record.
There are two varieties of sarcoma of the uterus: diffuse sarcoma of the mucous membrane, and sarcoma of the uterine parenchyma.
In diffuse sarcoma of the mucous membrane the endometrium is infiltrated by round or spindle cells. Soft projections or tumors, which may be villous, lobulated, or polypoid in shape, are formed upon the mucous membrane.
The polypoid sarcoma may present at the cervix uteri. The disease extends to the muscular coat of the uterus.
