Endometrial Cancer on Ultrasound

Endometrial cancer is often suspected after an abnormal ultrasound demonstrating endometrial thickening.  Endometrial cancer often presents in women after menopause with vaginal bleeding.  Some of the risk factors for endometrial cancer include : obesity, diabetes, hormone replacement, and tamoxifen.

What does endometrial cancer look like on Ultrasound?

Endometrial cancer is suspected when the endometrium is thickened in a post menopausal women with vaginal bleeding.  Approximately 10% of cases occur in women before menopause.  Thickening of the endometrium in these women depends on the phase of the menstrual cycle.  Not all cases occur with vaginal bleeding.

Normally the cutoff for thickness of the endometrium is 5 mm for a women after menopause.  8 mm is the cutoff for a women who is on hormone replacement or tamoxifen.  The cutoff is variable in women before menopause depending on the phase of the cycle.  Generally greater than 15 mm is abnormal no matter what the phase is.

Features that make cancer especially suspicious are heterogeneity and irregular thickening of endometrium, mass lesion in endometrium or invasion of the uterine wall.  Ascites, pelvic masses and enlarged lymph nodes are some additional findings that may be seen with endometrial cancer.

How is endometrial cancer diagnosed and staged?

Endometrial cancer is suspected on a transvaginal ultrasound when the endometrium is above stated cutoffs for thickness or if there is mass.  Clinical symptoms such as vaginal bleeding increases risk.  Sampling of the endometrium is needed for definitive diagnosis.

Endometrial cancer extent can be evaluated with MRI.   This can determine whether the tumor has invaded the uterine wall, whether it involves the cervix and vagina, whether it has spread outside the uterus, and if it involves lymph nodes or adjacent structures in the pelvis.   Highest stage cancer involves distant sites like spread to the lungs.  Surgical staging involves analysis after hysterectomy, removal of ovaries and tubes, lymph node removal and washings of the peritoneum.

What are some other conditions that can look like endometrial cancer on Ultrasound?

Endometrial hyperplasia is an abnormal proliferation of endometrium.        The changes can range from benign to cancerous.  This can affect women of all ages.  Women can present with vaginal bleeding.  This can look similar on ultrasound with thickening of the endometrium.

Rarely polyps which fill the endometrial cavity can results in thickened endometrium.  Intrauterine blood clots can result in irregular thickening of the endometrium. Endometritis or infection of endometrium can have a similar appearance.  Incomplete abortions with retained products can result in thickening and masses in endometrium.  Fibroids in the uterine cavity can mimic an endometrial cancer.

Endometrial cancer is often suspected on ultrasound when there is thickening of the endometrium.  This often presents with vaginal bleeding in women after menopause.   The imaging is non specific and tissue sampling is needed for definitive diagnosis.  MRI can help with staging.



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