Color Doppler sonography for diagnosing endometrial malignancies

Color Doppler

The Role of Color Doppler Sonography in Diagnosis of Endometrial Malignancies

As technology continues to advance doctors find they are able to evaluate and treat malignancies of the reproductive and genital organs in their earliest stages. With prompt attention, many of the highest risk cancers faced by women are treatable, and often curable depending on the nature and severity of the illness in question. This research concentrates on the use of Color Doppler Sonography when diagnosing endometrial malignancies.

Recent studies suggest Doppler sonography may be more beneficial for women with cancer as it provides doctors with a simpler tool they can use to distinguish endometrial malignancies from other malignancies or masses within the genital or reproductive system. While not the only tool used by doctors, the use of color Doppler is becoming increasingly popular and saving patients much in the way of anxiety and health risk.

Endometrial Malignancy Overview

Endometrial malignancy is best defined as abnormal growth of or carcinoma of the endometrium in women (Walsh & Goplerud, 1982). This growth may present as a mass within the endometrium. Often endometrial malignancies are confused with other masses or malignancies of the genital and reproductive tracts including polyps, fibroids and benign masses. The endometrium is best described as the material or tissue that lines the uterus, an organ that nestles in the pelvis and supports fetal growth during pregnancy (NCI, 2003).

Walsh & Goplerud note endometrial cancer is among the more common forms of "invasive" cancer affecting the reproductive system inclusive of the genital tract (p.1149). Because of this it is more important than ever women find effective tools to diagnose malignancies and distinguish malignancies as early as possible to improve their odds of survival and enjoying a higher quality of life.

Symptoms and Manifestations of EM

As with many malignancies or cancers of the genital tract or reproductive system, manifestation or symptoms of endometrial malignancies often are mistaken for symptoms of other common problems. Women with endometrial malignancies often do not seek treatment immediately because they believe their symptoms to be the result of some other ailment, even common problems like yeast infections (Birnbaum, 1991). Unfortunately such assumptions on behalf of the patient or by doctors can be deadly. This is one reason all symptoms, regardless of their severity, should be reported to a professional as soon as possible for evaluation and treatment recommendations.

Symptoms of endometrial malignancies may include changes in vaginal discharge, discharge accompanied by strong odors, pain in the abdomen or pelvis and other symptoms, symptoms that often mimic those of other diseases (NIC, 2003). Because these symptoms are similar to many benign diseases, many women do not detect endometrial masses in their earliest stages. Other signs of manifestation may include irregular bleeding not associated with a woman's normal menstrual cycle, pressure or pain during or after intercourse and abdominal pain of unknown origin (NIC, 2003).

UA/EVU/TVS

Ultrasound, endovaginal ultrasound and transvaginal sonography have all been used to help identify malignancies within the reproductive organs including the uterus. Of these, the more effective of tools is Color Doppler Sonography, because it allows physicians to distinguish benign masses from malignant masses more easily than do traditional U/S, EVU and TVS techniques. The advantages of U/S, EVU and TVS include the relatively low risk of complications and exposure to radiation which may prove more dangerous than beneficial. In times of old CT scans were often used in an attempt to try to identify malignancies of the uterus and endometrium (Ross & Goplerud, 1982). Today, by combining techniques, many doctors find it is much easier to exclude cancer from other benign masses or other malignant processes, which can save women laborious procedures including laparoscopic surveillance of the genital or reproductive tract (NIC, 2003). Because so many different malignancies and benign growths are present in a woman's reproductive organs, it is essential doctors recognize a polyp from a hematoma or fibroid masses from endometrial malignancies (NIC, 2003).

Traditionally, doctors have relied on endometrial biopsy and dilatation and curettage or D&C to remove samples of tissue from the uterine lining to detect malignancies or cancer (NIC, 2003). Traditional ultrasound has also been used in an attempt to identify masses or distinguish masses from malignant growths within a woman's reproductive tract (NIC, 2003). Unfortunately traditional ultrasounds are far less effective in distinguishing malignant growths from benign growths, thus serve little purpose as modern technology continues to produce new technologies for identifying and classifying masses within the endometrium (NIC, 2003). Color Doppler Sonography however, often clearly defines and distinguishes endometrial malignancies from other malignancies in the body, improving the odds a woman will receive prompt and efficacious treatment for her condition (Fleischer, et al., 2006). Many technologies including those that evaluate other malignancies like those that grow within the stomach are also taking advantage of color sonography to distinguish benign malignancies from other masses. This is an important advantage of color Doppler, because in the past doctors often had to use several different approaches to while attempting to discern what "type" of malignancy a woman develops. The type of malignancy present often affects treatment outcomes. For this reason researchers are now more likely to promote use of color Doppler in many other areas of women's health.

Fleischer, et al. (2006) provide ample evidence as to the efficacy and role of color Doppler to exclude endometrial cancer from other objects including masses within the uterus, malignancies and related growths, hematometra and related substances. The researchers performed a retrospective analysis of pre and postmenopausal women with abnormal bleeding. The women in the study had color Doppler sonography along with pathological studies of masses within the endometrium (Fleischer, et al., 2006). The results of their study showed color Doppler to be efficacious in differentiating malignancies from other masses including polyps in women with above average thickening of the endometrium (Fleischer, et al., 2006).

Fleischer et al., (2006) also report on the use of endovaginal ultrasound in evaluating masses within the endometrium. Their studies included a meta-analysis of the role endovaginal ultrasound had in differentiating benign vs. malignant masses in the endometrium. The results of this study suggest while endovaginal ultrasound alone is not effective to "exclude benign causes" of abnormal bleeding among women (Fleischer et al., 2006). When paired however with endometrial biopsy the EVUS or endovagional ultrasound technique proves very effective at distinguishing benign from malignant masses especially in post menopausal women.