How does endometrial cancer appear on ultrasound

An endometrial measurement greater than 4 mm that is incidentally discovered in a postmenopausal patient without bleeding need not routinely trigger evaluation, although an individualized assessment based on patient characteristics and risk factors is appropriate.

Transvaginal ultrasonography is not an appropriate screening tool for endometrial cancer in postmenopausal women without bleeding. The American College of Obstetricians and Gynecologists makes the following recommendations and conclusions: The clinical approach to postmenopausal bleeding requires prompt and efficient evaluation to exclude or diagnose endometrial carcinoma and endometrial intraepithelial neoplasia.

Transvaginal ultrasonography can be useful in the triage of women in whom office endometrial sampling was performed but tissue was insufficient for diagnosis.

Failure to adequately identify a thin, distinct endometrial echo in a postmenopausal woman with bleeding should trigger sonohysterography, office hysteroscopy, or endometrial sampling. An axial uterus, obesity, coexisting myomas, adenomyosis, or previous uterine surgery can contribute to difficulty in obtaining reliable transvaginal ultrasound assessment of endometrial thickness and texture. Because rare cases of endometrial carcinoma particularly type II can present with an endometrial thickness of less than 3 mm, persistent or recurrent uterine bleeding should prompt a histologic evaluation of the endometrium regardless of endometrial thickness.

Cancer of the endometrium is the most common type of gynecologic cancer in the United States. In , an estimated 61, new cases of uterine cancer were diagnosed and an estimated 10, deaths occurred 1.

Postmenopausal vaginal bleeding usually is caused by atrophic changes of the vagina or endometrium. This Committee Opinion describes the use of transvaginal ultrasonography for the evaluation of women with postmenopausal bleeding as well as the approach to the incidental finding of a thickened endometrial echo in asymptomatic postmenopausal women. Endometrial thickness is measured as the maximum anterior—posterior thickness of the endometrial echo on a long-axis transvaginal view of the uterus.

The earliest reports comparing transvaginal ultrasonography with endometrial sampling consistently found that an endometrial thickness of 4—5 mm or less in women with postmenopausal bleeding reliably excluded endometrial cancer 7 8 9. Since that time, a number of confirmatory multicenter trials have been completed Table 1.

Ultrasonography to measure endometrial echo should be offered as an initial evaluation only to women with postmenopausal bleeding for whom no further evaluation would be needed if a thin echo is found. Persistent or recurrent bleeding should trigger additional evaluation. Ultrasonography should be used only for patients whose prior probability of cancer and hyperplasia is low enough that no additional testing would be required after a normal ultrasonography.

Endometrial sampling also is a reasonable first approach for women with postmenopausal bleeding This initial evaluation does not require performance of both tests. A retrospective cohort study of 4, women conducted in Hong Kong assessed endometrial cancer detection rates based on different cut-off levels and concluded that the predetermined threshold for further evaluation should be based on available resources, comorbidities, and acceptable detection rates Endometrial sampling should be the first-line test for women with postmenopausal bleeding at higher risk based on clinical risk factors or clinical presentation of endometrial cancer and endometrial intraepithelial neoplasia.

Table 2 demonstrates the number of cases of endometrial cancer missed by transvaginal ultrasonography based on different thresholds. However, a thickened endometrial echo is not diagnostic of any particular pathology. Even with an extremely high probability that a woman with a negative screening test result truly does not have the condition, a thin endometrial echo does not exclude all possibilities of disease.

Furthermore, a thin endometrial echo does not reliably exclude type II endometrial cancer uterine papillary serous, mucinous, clear cell Research ethics and guidelines Learn about our research ethics and research practice guidelines.

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Nurse Ambassador Program. Nurse scholarships. Optimal Care Pathways The Optimal Care Pathways formerly Patient Management Frameworks were developed to provide a consistent statewide approach to care management in each tumour stream. Endometrial cancer is graded on a scale of 1 to 3 based on how much it looks like normal endometrium. See What Is Endometrial Cancer? Women with lower grade cancers are less likely to have cancer in other part of their body and are less likely to have the cancer come back after treatment recur.

If the doctor suspects hereditary non-polyposis colon cancer HNPCC as an underlying cause of the endometrial cancer, the tumor cells can be tested for protein and gene changes. If the doctor suspects that your cancer is advanced, you'll probably have to have other tests to look for cancer spread. A plain x-ray of your chest may be done to see if cancer has spread to your lungs. The CT scan is an x-ray procedure that creates detailed, cross-sectional images of the inside of your body. For a CT scan, you lie on a table while X-rays are done.

Instead of taking one picture, like a standard x-ray, a CT scanner takes many pictures as the camera rotates around you. A computer then combines these pictures into an image of a slice of your body. The machine will take pictures of many slices of the part of your body that's being studied. CT scans are not used to diagnose endometrial cancer.

But they can help see if the cancer has spread to other organs and to see if it has come back after treatment. MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases.

A computer translates the pattern of radio waves given off by the tissues into a very detailed image of the inside of the body. This creates cross sectional slices of the body like a CT scanner and it also makes slices that are parallel with the length of your body. MRI scans are very helpful for looking at the brain and spinal cord. Some doctors also think MRI is a good way to tell whether, and how far, the endometrial cancer has grown into the body of the uterus.

MRI scans may also help find enlarged lymph nodes with a special technique that uses very tiny particles of iron oxide. Your doctor may ask:. Endometrial cancer care at Mayo Clinic. Mayo Clinic does not endorse companies or products.

Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. Diagnosis Diagnosing endometrial cancer Pelvic exam Open pop-up dialog box Close.

Pelvic exam During a pelvic exam, your doctor inserts two gloved fingers inside your vagina. Transvaginal ultrasound Open pop-up dialog box Close.

Transvaginal ultrasound During a transvaginal ultrasound, your doctor or a medical technician inserts a wandlike device transducer into your vagina while you are positioned on an exam table. Hysteroscopy Open pop-up dialog box Close. Hysteroscopy During a hysteroscopy, your provider uses a thin, lighted instrument hysteroscope to view the inside of your uterus. Care at Mayo Clinic Our caring team of Mayo Clinic experts can help you with your endometrial cancer-related health concerns Start Here.

Share on: Facebook Twitter. Show references AskMayoExpert. Endometrial cancer. Rochester, Minn. Niederhuber JE, et al. Uterine cancer. In: Abeloff's Clinical Oncology. Philadelphia, Pa. Accessed May 24, Lobo RA, et al. Neoplastic diseases of the uterus. In: Comprehensive Gynecology.