CANCER

CANCER DETECTION

Ultrasound can be done a few ways depending on the patient, the reason for the ultrasound, and the request from the referring doctor or healthcare provider:

Cancer of the gynecologic organs is possible in anyone assigned female at birth, though not common. The main gynecologic structures that can possess cancer are the uterus, cervix, and ovaries. While the investigation for and diagnosis of cervical cancer is not usually based on imaging tests, uterine and ovarian cancer investigation will usually involve an ultrasound.

Uterine / Endometrial Cancer

Excluding the cervix, the uterus is essentially made up of two areas - the endometrium and the myometrium. Endometrial cancer is more common than cancers of the myometrium (usually called sarcomas). Endometrial cancer is more common in postmenopausal people.

A person is considered to be menopausal when a year has passed since their last period. Any bleeding after this time is always considered to be potentially abnormal - and this raises the concern for potential cancer or pre-cancerous changes of the endometrium. However, there are many more common benign causes of postmenopausal bleeding and only a small proportion of people who bleed after menopause have anything significantly wrong.

When postmenopausal bleeding occurs, ultrasound can be used to evaluate the uterus and specifically, the endometrium. The endometrial lining can be measured using ultrasound. There are many studies that show that if the lining of the uterus is thin (< 5mm), then it is very unlikely that there is anything significantly wrong.

In this way ultrasound can be used to reduce the need for unnecessary and more invasive investigation. If the endometrial thickness is increased, then Saline Infusion Sonohysterography (SIS) can be performed to assess for intra-cavitary focal lesions such as endometrial polyps. Though not done at the same time as ultrasound in most settings, an endometrial biopsy may be done to collect a sample of the tissue for a pathologist to evaluate under a microscope for cancer or pre-cancerous cell changes.

Ovarian Cancer

Some details about ovarian cysts in general and the approach we take at SUGO can be found here. Ovarian cancer is rare, but a diagnosis is of the utmost importance so that therapy can be faciliated as soon as possible. Besides benign ovarian cysts, ovarian cysts can be borderline or cancerous, both of which are considered in the “cancer” umbrella. Borderline cysts are sometimes referred to as “tumors of low malignant potential” or “atypical proliferative tumors”. Borderline cysts usually need to be removed as they have a dangerous potential. Patients with borderline cysts could have fertility-preserving surgery if desired.

In most cases, ovarian cancer can be differentiated from benign cysts and from borderline cysts using ultrasound. The key is that ultrasound examination and interpretation, like any diagnostic imaging test, is dependent on the skill and experience of the examiner as well as the quality of the ultrasound equipment. At SUGO, we are able to differentiate between benign, borderline and cancerous ovarian cysts in most cases by performing a systematic and detailed analysis of the cyst appearance using the IOTA group approach and predictive models such as ADNEX. In some cases, the diagnosis can be augmented by a blood test like CA125. The information gained from a high quality ultrasound can enable expeditious care to the right doctor, whether that is a gynecologic oncologist or general gynecologist.