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Query: UMLS:C0476089 (endometrial cancer)
 11,379 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Transvaginal US is often the initial imaging examination for women with dysfunctional (postmenopausal or intermenstrual) uterine bleeding. However, once the diagnosis of endometrial cancer has been made, contrast-enhanced MRI should be performed in patients who require multifactorial assessment (eg, depth of myometrial invasion, cervical involvement, lymph node metastasis). The results of contrast-enhanced MRI help distinguish patients who need more aggressive therapy and referral to a gynecologic oncologist from those who will do well treated by a community gynecologist.
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PMID:Imaging of cancer of the endometrium. 1211 93

Cancer of the endometrium is the most common invasive gynecologic malignancy in North America. Although transvaginal sonography is often the initial imaging examination in women with dysfunctional uterine bleeding, MRI offers multifactorial assessment once the diagnosis of endometrial cancer has been established. Specifically, preoperative contrast-enhanced MRI alters the likelihood ratios for myometrial invasion, which in turn affects type and extent of surgery performed. This information also helps identify patients who would most benefit from referral to a tertiary care center for treatment by a gynecologic oncologist.
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PMID:Imaging of cancer of the cervix. 1211 94

Our objective was to evaluate the usefulness of MRI including dynamic study in differentiating malignant, mixed mesodermal tumor (MMMT) from endometrial carcinoma (EC). The MR images were reviewed in 4 patients with histologically confirmed MMMT and 11 patients with EC. Flow voids inside and/or around the tumors were seen in 2 patients with MMMT but not in any EC cases. In dynamic studies, all 4 patients with MMMT showed areas of early and persistent marked enhancement similar to that of the myometrium, mixed with areas of gradual and delayed marked enhancement. The portions showing early and persistent enhancement histologically corresponded to predominantly sarcomatous components with prominent vascularity. Ten of 11 ECs did not show such enhancement and only one showed a rapid enhancement in the early phase which was diminished in the delayed phase. The MR imaging with a gadolinium-enhanced dynamic study seems to be useful in differentiating MMMT from EC.
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PMID:MRI findings including gadolinium-enhanced dynamic studies of malignant, mixed mesodermal tumors of the uterus: differentiation from endometrial carcinomas. 1238 66

To evaluate the myometrial infiltration of the endometrial cancer prior to aggressive treatment, dynamic MRI (magnetic resonance imaging) has attracted attention. However, it has also been found that in a number of cases, MRI exhibits inconsistent results with regards to the extent of the infiltration into this component of the uterine body. To overcome this limitation, the authors designed a method to delineate the tumor morphology more clearly by injecting CO2 gas into the uterine cavity. This procedure was combined with VIBE (volumetric interpolated breath-hold examination) to determine more precisely the depth of the tumor invasion. From our clinical results, the efficacy of the method was evaluated. On four patients with endometrial cancers (stage Ia-Ic), CO2 was injected to dilate the intra-uterine space through a catheter equipped with a balloon that had been introduced into the uterine cavity, after which VIBE was conducted. The images were interpreted by MPR (multiplanar reconstruction) and the findings from these images were compared against the histopathological findings. By employing this method, it was possible to delineate clearly the tumorous lesion in the uterine body, and three-dimensional images of the tumor invasion was acquired. The site and extent of tumor invasion in the myometrium were generally consistent with the histopathological findings. This method allows one to observe multiple planes by using thin slices. By dilating the uterine cavity, the site of involvement and the extent of invasion can be more precisely defined before treatment. It is truly a revolutionary procedure for determining-prior to surgery-the depth of invasion of a cancer located in the uterine body.
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PMID:Evaluation of endometrial cancer with 3D-VIBE (volume interpolated breath-hold examination) using intrauterine CO2 gas. 1241 1

Thickened or indistinct junctional zone (JZ) is a problematic finding in staging endometrial carcinoma. We studied the incidence, pathological cause of this condition correlated to microcirculation, and the utility of dynamic contrast MRI for differential diagnosis. T2-weighted images were analyzed in 119 cases with endometrial carcinoma. The enhancement of the JZ during the dynamic contrast MRI, histopathological causes, and the density of arterioles in the JZ were retrospectively analyzed in cases with thickened or indistinct JZ. The MRI histopathological correlation of all 31 patients with a thickened or indistinct JZ were analyzed, in which it was corresponded to myometrial cancer invasion only in 22%. The sensitivity of a poor early enhancement pattern on dynamic study for detecting myometrial invasion was 71.4%, the specificity was 100%, and the overall accuracy was 92.5%. Although only weak relationship between the contrast enhancement and the arteriole density was revealed, the arteriole density within the JZ with cancer invasion was significantly decreased. Poor enhancement of JZ in early dynamic phase was correlated with the decreased density of arterioles within the myometrium which was invaded by endometrial carcinoma. Dynamic contrast study should be performed in staging endometrial carcinoma especially when JZ was thickened or indistinct.
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PMID:A thickened or indistinct junctional zone on T2-weighted MR images in patients with endometrial carcinoma: pathologic consideration based on microcirculation. 1294 5

Tamoxifen estrogenic action in the uterus induces several uterine diseases, benign and/or malignant ones. The risk of endometrial adenocarcinoma is multiplied by two to three in post-menopausal women. It is mainly linked with the doses and the length of the treatment. However, the global benefit of that drug is not questioned anymore. What matters now though is to find the best way to follow patients on tamoxifen. As a matter of fact, there is no such thing as a consensus that would include specific tests, nor a surveillance protocol in women on tamoxifen. Most teams do not propose any special follow-up. Some patients already show uterine anomalies prior to the beginning of tamoxifen treatment. A yearly gynecologic examination, together with a cervico-vaginal smear, is enough when there are no specific endometrial adenocarcinoma risk factors, nor anomalies detected during the pre-therapeutical evaluation, nor clinical symptomatology. In case of risk factors, or cervical stenosis, or again initial abnormalities though, a yearly transvaginal sonography may be proposed. There is no need for other exploratory examinations if the results are satisfying. In case of symptoms, anomalies in the cervico-vaginal smears, intra-uterine liquid retention with a stenosed cervix, or suspicious endometrial thickness, then an endometrial sampling must be carried out. MRI could be of interest in asymptomatic patients with unclear ultrasonography images. Follow-up must be continued after interruption of tamoxifen. It is important to inform patients about the additional risks of developing an endometrial cancer because of tamoxifen, while still being reassuring. Besides, it is absolutely necessary to recommend them to take quickly medical advice in case of gynecologic symptoms.
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PMID:[Endometrial surveillance of women on tamoxifen]. 1456 11

Carcinoma of the endometrium is the most common female pelvic malignancy in the US. Although it is primarily a disease of the postmenopausal female, 25% of patients are premenopausal, with 3-5% in women 40 years old or younger. The younger group of women with endometrial carcinoma are frequently nulligravid with a history of infertility, and a strong desire to preserve fertility. This may pose a therapeutic dilemma for both patients and treating physicians. Medical treatment for young patients with grade 1 endometrial carcinoma who wish to preserve fertility is a reasonable and appealing option. A comprehensive evaluation prior to counseling the patient should include. A complete history and physical examination. A formal D&C with review of histology with an experienced gyn-onc pathologist. Evaluation of the pelvic and abdomen preferably with contrast-enhanced MRI or transvaginal ultrasound. In patients found to have a clinical stage I grade 1 tumor and who want to preserve fertility, thorough counseling including risks and benefits, and explanation that the data is partial and incomplete due to the lack of appropriate controlled studies is mandatory. In patients considered for medical treatment, a high dose progestin regimen should be started with endometrial sampling every 3 months until complete regression of the tumor is documented. For patients willing to conceive at this stage, treatment options should be discussed. In women who do not want pregnancy at this stage, a maintenance treatment with oral contraceptive agent or Depo-provera (medroxyprogesterone acetate 150 mg i.m. q 12 weeks) should be recommended, with periodic ultrasound evaluation of the endometrium. When the patient finishes her fertility plans, the option of hysterectomy should be considered. Although most responses are long standing, there is a small risk of progression during or after cessation of progestin therapy.
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PMID:Endometrial adenocarcinoma in young patients: evaluation and fertility-preserving treatment. 1554 46

Complex endometrial hyperplasia with atypia (CEHA) often precedes an endometrial carcinoma. A nulli-gradiva woman at high risk due to various complications underwent microwave endometrial ablation (MEA) at a frequency of 2.45 GHz for treatment of CEHA as an alternative to hysterectomy. The endometrium near the internal orifice was conserved to avoid hematometra. Endometrial biopsy specimen from the neighborhood of the internal orifice did not show any signs of endometrial hyperplasia postoperatively. Two years after the operation, endometrial biopsy revealed recurrence. The second MEA was performed. MRI one month after the second operation revealed that the uterine lining was completely replaced by avascular area without signs of regrowing endometrium or endocevix. Eighteen months have passed without recurrence.
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PMID:[A case of complex endometrial hyperplasia with atypia treated by microwave endometrial ablation]. 1631 98

Most positron emission tomography (PET) imaging studies in gynecologic cancer are performed using (18)F-fluorodeoxyglucose (FDG). It contributes valuable information in primary staging of untreated advanced cervical cancer, in the post-treatment surveillance with unexplained tumor marker (such as squamous cell carcinoma antigen [SCC-Ag]) elevation or suspicious of recurrence, and restaging of potentially curable recurrent cervical cancer. Its value in early-stage resectable cervical cancer is questionable. In ovarian cancer, FDG-PET provides benefits for those with plateaued or increasing abnormal serum CA 125 (>35 U/mL), computed tomography and/or magnetic resonance imaging (CT-MRI) defined localized recurrence feasible for local destructive procedures (such as surgery, radiotherapy, or radiofrequency ablation), and clinically suspected recurrent or persistent cancer for which CT-guide biopsy cannot be performed. The role of FDG-PET in endometrial cancer is relatively less defined because of the lack of data in the literature. In our prospective study, FDG-PET coupled with MRI-CT may facilitate optimal management of endometrial cancer in well-selected cases. The clinical impact was positive in 29 (48.3%) of the 60 scans, 22.2% for primary staging, 73.1% for post-therapy surveillance, and 57.1% after salvage therapy, respectively. Scant studies have been reported in the management of vulvar cancer using FDG-PET. More data are needed. Gestational trophoblastic neoplasia is quite unique in biological behavior and clinical management. Our preliminary results suggest that FDG-PET is potentially useful in selected gestational trophoblastic neoplasia by providing a precise metastatic mapping of tumor extent up front, monitoring response, and localizing viable tumors after chemotherapy. The evaluation of a diagnostic tool, such as PET, is usually via comparing the diagnostic efficacy (sensitivity, specificity, etc), by using a more sophisticated receiver operating curve method, or the proportion of treatment been modified. Evaluating PET by clinical benefit is specific to the individual tumor and an attractive new endpoint.
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PMID:Positron emission tomography in gynecologic cancer. 1635 98

The purpose was to evaluate the safety and efficacy of high-dose-rate (HDR) CT-guided interstitial brachytherapy in the treatment of extrahepatic, extrapulmonary, secondary malignancies. Nineteen patients were included in this prospective study. The median age was 66 years (49-77). Underlying primaries comprised colorectal carcinomas in six, renal cell carcinoma in three, pancreatic carcinoma in three, cervical cancer in two, endometrial cancer in two and NSCLC, breast cancer and sarcoma in one patient each. All patients had undergone extensive pretreatments. CT-guided HDR brachytherapy employed a 192Iridium source. Dose planning for brachytherapy was performed using 3D CT data acquired after CT-guided percutaneous applicator positioning. MRI follow-up was performed 6 weeks and every 3 months post intervention. Primary endpoints were complications, local tumor control and progression-free survival. The median tumor diameter was 6 cm (2-15 cm). Tumor locations included the hepatoduodenal ligament, mesentery, adrenal gland, mesogastrium and local recurrences after rectal or pancreatic cancer. The minimal median dose in the target volume was 11 Gy (4-18 Gy). Minor complications comprised pain and fever (n=6, 32%). Major complications included one hospital death of unknown causes (n=1; 5%). Median follow-up was 7 months (1-16). Four patients (21%) died during the follow-up period. Local tumor control was 76.5% after 6 months and progression-free survival 47% after 6 months. Minimally invasive CT-guided HDR brachytherapy is safe and effective in the palliative treatment of extrahepatic, extrapulmonary secondary malignancies.
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PMID:CT-guided interstitial brachytherapy in the local treatment of extrahepatic, extrapulmonary secondary malignancies. 1662 47


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