Screening, Diagnosis and Stages of Endometrial Cancer

Screening

Screening tests aim to find a disease before symptoms appear, while diagnostic tests are used when symptoms are present.

Currently, there are no standard screening tests for endometrial cancer or uterine sarcoma. While Pap tests don't screen for endometrial cancer, they can sometimes reveal abnormalities in the uterine lining, prompting further tests that may detect cancer. However, if you are at higher risk or experience symptoms like irregular menstrual bleeding, it's important to see a gynecologist. The doctor will likely begin with a physical exam and a pelvic ultrasound, but uterine cancer can only be diagnosed through a biopsy, where a tissue sample is examined.

At Dana-Farber Brigham Cancer Center, our team may conduct additional exams besides checking your medical and family history. In addition to a pelvic exam and Pap test, you may have one or more of the following diagnostic tests:

• Transvaginal Ultrasound: This non-invasive imaging test uses sound waves to generate images of the uterus. A small device called a transducer is inserted into the vagina to capture these images. The ultrasound can detect tumors and measure the thickness of the endometrium. If the endometrium appears excessively thick, a biopsy may be performed for further evaluation. In some cases, the uterus is filled with salt water prior to the ultrasound, known as a hysterosonogram or saline infusion sonogram, to enhance the visualization of changes in the uterine lining.
• Endometrial Biopsy: To confirm the presence of cancer, a biopsy is performed. This procedure involves obtaining small tissue samples from the endometrium, which are then examined under a microscope. A flexible tube is gently inserted into the uterus, and suction is used to extract the tissue.
• Dilation and Curettage (D&C): In cases where an endometrial biopsy is not feasible or further information is required, a D&C may be recommended. This minor surgical procedure is usually performed in the operating room and it involves dilating the cervix and using a spoon-shaped instrument called a curette to scrape the cervical canal and uterine lining. The collected tissue is then examined by a pathologist for the presence of cancer cells. In some instances, a hysteroscopy, which involves inserting a thin tube with a camera into the uterus, may be performed simultaneously to visualize the uterine cavity.

To gather information and determine the best treatment plan, your healthcare provider may also perform additional tests after diagnosis, including blood tests, computed tomography (CT) scan and magnetic resonance imaging (MRI) scans. Blood tests can help find certain markers or hormones that may indicate the presence of cancer. CT and MRI scans provide detailed images of the pelvic area, allowing for doctors to see the uterus and surrounding structures.

Learn more about early detection tests (for those who area at higher-than-average risk), diagnostic tests and post-diagnostic tests.

Stages of Endometrial Cancer

After receiving a diagnosis of endometrial cancer, our team will try to determine your stage of cancer. The stage describes if and how much the cancer has spread in the body. Understanding your stage of cancer helps your care team determine the most effective way to treat your cancer.

Nearly 70 percent of patients with endometrial cancer have early-stage uterine cancer, meaning the cancer is confined within the uterus. Twenty percent of patients with endometrial cancer have cancer that has spread to nearby organs and lymph nodes. The remaining 10 percent of patients with endometrial cancer have cancer that has spread — or metastasized — to distant parts of the body.

Endometrial cancer is staged based on three primary factors: the size and extent of the tumor—how deep into the uterine wall it has grown,—the involvement of nearby lymph nodes and the presence of metastasis to distant sites. The International Federation of Gynecology and Obstetrics (FIGO) classification system categorizes endometrial cancer into four stages:

• Stage I: In this stage, the cancer is confined to the endometrium and/or the muscle layer of the uterus (myometrium).
• Stage II: Cancer has spread beyond the uterus to the cervix or to the stromal connective tissue where the cervix and uterus meet.
• Stage III: Cancer has spread beyond the uterus and cervix, but it is still only in the pelvic area, affecting the vagina, ovaries, fallopian tubes and/or nearby lymph nodes.
• Stage IV: At this advanced stage, cancer has spread beyond the pelvis, such as the urinary bladder, rectum, or organs far from the uterus, including the lungs, liver or bones.