Diagnosis of Endometrial Cancer

Diagnostic tests

Diagnostic tests that can aid in identifying endometrial cancer include the following:

• Endometrial biopsy: If cancer is suspected, a sample of the endometrium is obtained through a biopsy. A biopsy is the removal of a very tiny piece of tissue from the body. The tissue is examined under a microscope for abnormalities that suggest cancer. Usually, a gynecologist or a gynecologic oncologist performs the biopsy, and the endometrial tissue is examined by a pathologist (a doctor who specializes in diagnosing diseases in this way). The most widely used method for obtaining the endometrial tissue is to insert a thin tube into the endometrium through the cervix. A biopsy is usually performed in the doctor’s office and takes just a few minutes. Often, the results of an endometrial biopsy give a definitive answer about cancer.
• Dilation and curettage: If the results of the endometrial biopsy are not conclusive, a procedure called a dilation and curettage (D&C) may be performed. In a D&C, the doctor passes a thin instrument through the dilated cervix and scrapes tissue from the endometrium. The tissue is removed and examined by a pathologist. This procedure is usually performed as outpatient surgery and requires general anesthesia or sedation. Most women have minimal discomfort after this procedure and require a short recovery time.
• Hysteroscopy: Sometimes, an endoscope is used to guide the endometrial biopsy or D&C. An endoscope is a thin tube with a tiny light and camera at the end. The tube is inserted into the uterus through the cervix. The endoscope sends pictures of the endometrium back to a video monitor. A hysteroscopy allows the doctor to view the inside of the uterus while collecting endometrial tissue samples.

Staging

Staging is a system for classifying cancers based on the extent of the disease. In general, the lower the cancer stage, the better the outlook for remission and survival. (Remission is when no evidence of cancer is found in the body.) Health care providers cannot make recommendations for the best treatment until they know the exact stage of cancer.

In endometrial cancer, staging is based on how far the primary tumor has spread, if at all. The staging system used for endometrial cancer was developed by the International Federation of Gynecology and Obstetrics (FIGO). The staging system for endometrial cancer is a surgical staging system, meaning that staging is based on the pathologist’s findings on examining organs removed during surgery.

The FIGO system uses 4 stages.

Stage I: The tumor is limited to the corpus (upper part) of the uterus and has not spread to the surrounding lymph nodes or other organs. • Stage IA – Tumor limited to the endometrium
•Stage IB – Invasion to less than one half the myometrium
•Stage IC – Invasion to more than one half the myometrium

Stage II: The tumor has spread from the corpus of the uterus to the uterine cervix but has not spread to the lymph nodes or other organs.
•Stage IIA – Involvement of only glandular tissue lining the cervix
•Stage IIB – Invasion of the cervical stroma (strong supportive connective tissue of the cervix)

Stage III: The cancer has spread outside the uterus but is confined to the pelvic area.
•Stage IIIA – Invasion of the serosa (outermost layer of the myometrium) and/or the adnexa (the ovaries or fallopian tubes) and/or cancer cells are found in the peritoneal cavity
•Stage IIIB – Invasion of the vagina but not to the lymph nodes or other organs
•Stage IIIC – Cancer has spread to the lymph nodes but not to distant organs

Stage IV: The cancer has spread to the inside (mucosa) of the bladder or the rectum (lower part of the large intestine) and/or to the lymph nodes and/or to the bones or distant organs outside the pelvis, such as the lungs.
•Stage IVA – Tumor invasion of the bladder, the bowel mucosa, or both
•Stage IVB – Metastasis to distant organs, including intra-abdominal metastasis, inguinal lymph nodes, or both

The tumor grade is also defined during the staging process. Grade indicates the aggressiveness of the cancer. Generally, low-grade tumors are less likely to metastasize or recur after treatment.

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