Learning objectives
To review the Fédération Internationale de Gynécologie et d'Obstétrique (FIGO) staging system for endometrial cancer.
To provide illustrative examples of local,
regional,
and distant spread of endometrial cancerutilizing ultrasound,
CT,
MR,
and PET/CT.
To demonstrate the utility of specific MR sequences and protocols in local and regional staging of endometrial cancer.
To demonstrate the utility of CT and PET/CT in assessing distant spread of tumor.
To understand the patient management implications of these findings.
Background
Introduction
Endometrial cancer is the most common gynecologic malignancy in industrialized countries,
second only to cervical cancer in the developing world,
and its incidence is increasing worldwide.
The main risk factors for endometrial carcinoma are those that result in prolonged exposure to “unopposed estrogen”: early menarche,
late menopause,
nulliparity,
hormone replacement therapy,
and obesity.
Obesity increases the likelihood of anovulatory cycles in premenopausal women and increases endogenous estrogens in postmenopausal women (by conversion of androgens to estrogens by adipose tissues).
Diabetes,
insulin resistance,
and certain...
Findings and procedure details
Overview
Initial ultrasound evaluation
MRI: locoregional staging
CT and PET/CT: distant tumor spread
Management decisions
Initial UltrasoundEvaluation
When endometrial cancer is suspected,
initial imaging evaluation is usually performed with pelvic ultrasound(Table 2).
Ultrasound is inexpensive,
readily available,
and provides high quality images of the uterus and adnexa.
Transvaginal pelvic ultrasound is preferred,
as image quality tends to be superior to transabdominal technique.
The key parameter in sonographicassessment of the uterus is endometrial thickness.
A widely cited meta-analysis by Smith-Bindman et al.
demonstrated that a cutoff...
Conclusion
Endometrial cancer is one of the most common malignancies worldwide.
While surgical staging is usually the standard of care for the treatment of endometrial cancer,
imaging plays an important role in initial diagnosis and nonoperative staging.
MRI canhelp guide the surgical approach and help provide important information for pretreatment risk stratification.
CT and PET/CT provide crucial prognostic information in high-risk cancers and when there is suspicion for advanced disease.
After surgical or nonsurgical treatment,
CT and PET/CT are also vital in monitoring treatment response and...
Personal information
Contact details:
Dr.
Alan Goldstein
Department of Radiology,
Division of Abdominal Imaging
UMass Memorial Medical Center
55 Lake Avenue North
Worcester,
MA 01655
Email:
[email protected]
Division of Abdominal Imaging:
Dr.
L.
McIntosh
Dr.
M.
Masciocchi
Dr.
Y.
Kim
References
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