The role of imaging in the management of endometrial cancer

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The role of imaging in the management of endometrial cancer
ANWEN E JELBERT FRCR., NISHAT BHARWANI FRCR.,
ANDREA G ROCKALL FRCR.
Radiology Department, St Bartholomews Hospital, West Smithfield, London

ABSTRACT Imaging in endometrial cancer helps guiding delivery of the most appropriate surgical intervention and adjuvant therapy for the patient. In this article, we review the imaging literature and describe how imaging findings are integrated into the management of patients with endometrial cancer at our tertiary referral centre. We will discuss all imaging modalities, with a particular focus on magnetic resonance imaging (MRI) and how to maximise the staging information available prior to intervention. Our discussion will also highlight circumstances which may limit the accuracy of imaging staging and touch on the role of imaging in the detection of recurrent disease.

Key words: Imaging, management, MRI, endometrial cancer, FIGO stage


INTRODUCTION In the UK, there were 6,891 new cases of endometrial cancer in 2005, and 1,651 deaths in 2006 (1). The incidence has increased from 5,624 new cases in 2000, and is now more than that for ovarian cancer. The majority of patients present with inter-menstrual or post-menopausal bleeding, with 80% having early (stage I) disease at presentation (2-5). The UK mortality fell by 27% between 1971 and 2005 (1). As a result, endometrial carcinoma is not a common cause of cancer death (6), with a 10 year survival of 75% (1).

Ninety per cent of endometrial carcinomas are adenocarcinomas (2, 5). Less common histological subtypes include adenocarcinoma with squamous differentiation, adenosquamous carcinoma, clear cell carcinoma and papillary serous carcinoma (2). The latter two histological subtypes carry a worse prognosis (2, 5). Other poor prognostic factors include deep myometrial invasion, cervical invasion, extra-uterine spread, lymph node involvement and a high histological grade (4, 7).

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