Endometrial cancer is the most common gynecological cancer in the general population. It typically affects postmenopausal women around age 65. Obesity, diabetes, hormone therapy, and tamoxifen use can increase risk. Patients often present with abnormal uterine bleeding. Ultrasound is used initially, with endometrial thickness under 5mm having a low risk of cancer. Sonohysterography may be used if the etiology of thickening remains unclear after biopsy or ultrasound. Features of cancer on ultrasound include heterogeneous thickening and loss of the endometrial-myometrial interface.
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Gynaecology Thicknend Endometrium leceture 3 part 2.pptx
1.
2.
3.
4. Endometrial Cancer
• In the general population, endometrial carcinoma
is the most common gynecological cancer.
• Endometrial carcinoma is more common during
the 6th and 7th decades of life, with the mean age
of patients being 65 years.
5. • However, in developing countries, it is the
second most common gynecologic malignancy
with an incidence of 5.9% per 100,000 women.
6. • Around 52,630 new cases of cancer involving the
uterine body, mostly endometrial, would be
diagnosed and approximately 8590 deaths from
this disease are estimated to occur in the United
States in 2014.
7. •Patients present with abnormal uterine
bleeding (postmenopausal) in more than
80% of cases.
9. 1)Changes in the balance of hormones
in the body
• The two main hormones the ovaries make are
estrogen and progesterone. Changes in the
balance of these hormones cause changes in the
endometrium.
10. • A condition that increases the amount of
estrogen, but not the level of progesterone, in the
body can increase the risk of endometrial cancer.
• Examples include obesity, diabetes and irregular
ovulation patterns, which might happen in
polycystic ovary syndrome.
11. • Taking hormone therapy medicine that contains
estrogen but not progestin after menopause
increases the risk of endometrial cancer.
12. 2) Older age
• As get older, risk of endometrial cancer is
increases. Endometrial cancer occurs most often
after menopause.
13. 3) Obesity
• Obesity contributes to the increased risk of
endometrial cancer in the postmenopausal uterus
by a variety of mechanisms.
• This may happen because extra body fat can
change the body's balance of hormones.
14. 4) Hormone therapy for breast cancer
•Taking the hormone therapy medicine
tamoxifen for breast cancer can increase the
risk of developing endometrial cancer.
15. • If women taking tamoxifen, talk about the risk
with health care team.
• For most, the benefits of tamoxifen exceed the
small risk of endometrial cancer.
18. Ultrasonography
• Transvaginal sonography is often used for the
initial evaluation in women with history of
postmenopausal bleeding because it is quick,
inexpensive, and does not expose the patient to
ionizing radiation.
19. • Initial preoperative evaluation of patients suspected of
endometrial carcinoma includes transvaginal
sonography (TVS), contrast-enhanced magnetic
resonance imaging (MRI) and endometrial biopsy.
• As a routine method, TVS plays a useful role in the
diagnosis of endometrial carcinoma.
20. • During the last few years, endovaginal ultrasound
has proven to be a valuable diagnostic tool for
studying the endometrium in women with
postmenopausal bleeding.
21. Note: Double layer: Endometrium comprises two layers, Basal layer and functional layer.
Adjacent to the myometrium basal layer is present and adjacent to uterine cavity functional layer is
present.
• Some studies suggest that, in postmenopausal
bleeding an endometrial thickness less than 5mm
(double layer) excluded endometrial carcinoma.
22.
23. • Furthermore, several studies performed in
women with postmenopausal bleeding have
shown that a thin endometrium (<5mm, double
layer) seems to be associated with a low risk for
uterine pathology.
24. • The value of vaginal ultrasound for the
assessment of endometrium in women at risk for
endometrial cancer make the technique very
attractive for identifying myometrial infiltration
of an endometrial cancer.
Myometrial invasion/infiltration: Endometrial cells into myometrium.
25. Case study
• A 72-year-old female with endometrial cancer.
Longitudinal transvaginal scan through the uterus
demonstrates markedly thickened and heterogeneous
endometrium (arrows) with ill-defined anterior border
and no clear separation from the myometrium
(arrowheads), suggestive of myometrial invasion.
26.
27. • In recent studies, transabdominal sonography as
well as endovaginal sonography, has been use to
assess myometrial infiltration of endometrial
carcinoma and both have been shown to have a
high sensitivity.
28.
29.
30. Sonographic features
• Endometrial carcinoma usually appears as
thickening of the endometrium though may
appear as a polypoid (growth in the
endometrium) mass.
• Heterogeneous in echotexture.
31. • Irregular endometrial thickening.
• Loss of endometrial myometrial interface.
• Intrauterine fluid collection.
• Central or peripheral flow
32.
33.
34. Case study
• A 67-year-old female with endometrial cancer. (A) Longitudinal
transabdominal scan. (B) Transvaginal scan and a 3-D
reconstructed ultrasonography image (C) through the uterus
demonstrate a thickened and heterogeneous endometrium
measuring 2.0 cm (arrows). Note regular endometrial–
myometrial border with no signs of invasion (arrowheads). (D)
Note increased vascularity in the color Doppler US.
35.
36.
37. Sonohysterography
• When endometrial thickening is present
sonographically and the etiology is unclear (or if
the result of an endometrial biopsy is negative
despite an abnormal sonogram),
sonohystrerography often is helpful in identifying
the cause of the endometrial thickening.
38. Saline infusion Sonohysterography
(SIS)
• It provides a detailed imaging of both the uterine wall
and cavity. This technique has been found to be useful
in the evaluation of abnormal uterine bleeding.
• Postmenopausal bleeding.
• Postmenopausal women taking tamoxifen.
39.
40. • For this procedure, a catheter is placed into the
endometrial cavity under sterile conditions, and
10 ml of saline is injected into the endometrial
cavity to identify the cause of the thickening.
41. • In this manner, polyps and fibroids are outlined
and better characterized.
