From the Guidelines
When evaluating an abdominal scan following a total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAHBSO) for endometrial cancer, focus on several key areas, including local recurrence, lymph node enlargement, peritoneal carcinomatosis, and distant metastases, as recommended by the most recent guidelines 1.
Key Areas to Evaluate
- Local recurrence in the surgical bed, particularly in the vaginal cuff area
- Enlarged lymph nodes in the pelvis and para-aortic regions
- Peritoneal surfaces for nodular thickening or enhancement suggesting peritoneal carcinomatosis
- Liver, lungs, and bones for distant metastases
- Fluid collections representing postoperative complications like abscesses or lymphoceles
- Hydronephrosis indicating ureteral obstruction from recurrent disease
- Bowel obstruction signs related to adhesions or tumor recurrence
Importance of Early Detection
Early detection of recurrence allows for prompt intervention, potentially improving outcomes for patients with recurrent endometrial cancer, as supported by recent studies 1. The frequency of surveillance imaging typically follows a schedule of every 3-6 months for the first 2-3 years post-surgery, then annually thereafter, though this may vary based on the patient's specific risk factors, cancer stage, and histologic grade.
Imaging Modalities
While ultrasound remains a common imaging modality, state-of-the-art dynamic contrast-enhanced and diffusion-weighted imaging (DWI) MR techniques are better suited to preoperatively stage, identify recurrence, and assess local treatment response in women with endometrial cancer 1. CT scanning is also useful for detecting para-aortic nodal involvement 1.
From the Research
Abdominal Scan Post TAHBSO for Endometrial Cancer
When performing an abdominal scan post TAHBSO (Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy) for endometrial cancer, there are several key factors to look for:
- Recurrence of cancer: According to 2, recurrences occurred in five cases (33%) of Stage Ic with deep myometrial invasion, high histologic grade, large tumour size, and tumour emboli.
- Lymph node involvement: Studies such as 3 and 4 discuss the importance of lymphadenectomy in the treatment of endometrial cancer, highlighting the need to examine lymph nodes for potential cancer spread.
- Myometrial invasion: Depth of myometrial invasion is a significant factor in determining the risk of recurrence, as noted in 2.
- Histologic grade: The grade of the tumour is also an important factor, with higher grades indicating a greater risk of recurrence, as seen in 2.
- Tumour size and emboli: Large tumour size and presence of tumour emboli are also associated with an increased risk of recurrence, as reported in 2.
Imaging Modalities
The choice of imaging modality for abdominal scans post TAHBSO may depend on various factors, including the stage of cancer, patient's overall health, and institutional preferences. However, there is no direct evidence in the provided studies to support a specific imaging modality.
Complications and Morbidity
It is essential to be aware of potential complications and morbidity associated with TAHBSO and adjuvant therapies, such as radiotherapy, as discussed in 5. The study found that extended surgical staging (ESS) was associated with a higher complication rate compared to TAHBSO alone.
Surgical Approaches
Different surgical approaches, such as total laparoscopic hysterectomy (TLH) versus total abdominal hysterectomy (TAH), may have varying outcomes in terms of morbidity, cost-effectiveness, and quality of life, as investigated in 6. However, the study is ongoing, and results are not yet available.