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Endometrial Cancer - Diagnosis

How Is Endometrial Cancer Diagnosed? 
How Is Endometrial Cancer Treated? 
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How Is Endometrial Cancer Diagnosed?

Endometrial cancer may be diagnosed at any stage. If women experience any irregular vaginal bleeding, they should consult their physician immediately. Early stage diagnosis is beneficial because it will improve the outcomes for most women.

If your primary care physician suspects endometrial cancer might be the cause of your symptoms, you will be referred to a gynecologist or gynecologic oncologist, a doctor who specializes in treating conditions of the ovaries, uterus, and cervix. These specialists will use one or more of the following methods to diagnose endometrial cancer.

  • Physical Exam – In addition to asking you a series of questions, your physician is likely to do a physical exam, which may include a pelvic exam.

  • Sampling Endometrial Tissue – An endometrial biopsy is needed to confirm an endometrial cancer diagnosis and can be performed in the doctor's office. A thin flexible tube is inserted through the vagina and cervix into the uterus to obtain a tissue sample from the endometrium.

  • Hysteroscopy – A physician may also insert a very small camera through the vagina and cervix to observe whether there is any abnormal tissue in the uterus.

  • Dilation and Curettage (D&C) – If an endometrial biopsy is inconclusive in diagnosing a patient, a D&C may need to be performed to collect additional cells from the uterus lining. This is done as an outpatient procedure and may require general or local anesthesia.

  • Ultrasound – There are a variety of imaging tests that may be done to help diagnose endometrial cancer, but most often, endometrial cancer is diagnosed by performing an ultrasound. Ultrasound is a safe, noninvasive procedure that uses high-frequency sound waves to examine the abdomen. Ultrasound imaging—also called ultrasound scanning or sonography—provides real-time pictures of the body, and also evaluates size and movement of structures, such as blood flow. Transvaginal ultrasounds may also be used and are performed by inserting a small probe into the vagina to determine the general thickness of the endometrium.
  • Pathology – To confirm whether the symptoms are associated with endometrial hyperplasia (abnormal enlargement of the endometrium) or endometrial cancer, the biopsy of tissue removed from the endometrium must be sent to the pathology department for analysis. The pathologists will look at the tissue under a microscope to make a final diagnosis.
  • In collaboration with other specialists, your physician will likely order one or more diagnostic tests and review the results at a weekly Tumor Board meeting. This interdepartmental review process guides our recommendations for treatment. In consultations with you and your primary care physician, we plan the best course of treatment for you based on the type and stage of your cancer and your overall health.

    Staging

    Staging is an important part of diagnosis because it is used to determine the most appropriate treatment options for cancer patients. Staging is a process that is used to determine how extensive the cancer is. The stages of endometrial cancer range from Stage 0 to Stage IV.  Stage grouping derived from the American Joint Committee on Cancer (AJCC) is included below.

    • Stage 0: The cancer cells are known as carcinoma-in-situ, which means they are only found in the surface layer cells of the endometrium.
    • Stage I: The cancer is only growing in the uterus.
    • Stage II: The cancer has spread from the body of the uterus to the supporting connective tissue of the cervix.
    • Stage III: The cancer has spread to other areas outside of the uterus and cervix, but remains within the pelvis.
    • Stage IV: The cancer has spread to the inner surface of the bladder or rectum, and to regions outside of the abdomen, such as the lungs, liver, and/or other organs.

    For a more detailed description of staging, please refer to the chart below.

          Staging for Endometrial Cancer
    Stage 0 Cancer is present only in the surface cells of the endometrium.
    Stage I Cancer is present only in the uterus.
    Stage IA Cancer is present only in the endometrium or has spread less than halfway through the myometrium (the outer muscle layer of the uterus).
    Stage IB Cancer has progressed halfway or more through the myometrium.
    Stage II Cancer has spread to the connective tissue of the cervix, but is still contained to the uterus.
    Stage III Cancer has spread outside the uterus and cervix, but is contained to the pelvis.
    Stage IIIA Cancer has spread to the outer layer of the uterus and/or to the fallopian tubes or ovaries.
    Stage IIIB Cancer has spread to the vagina or the tissues and fat surrounding the uterus (called the parametrium).
    Stage IIIC1 Cancer may have spread to nearby tissues and to lymph nodes in the pelvis, but has not yet spread to lymph nodes around the aorta (the body's biggest artery, the aorta channels blood away from the heart to vessels that circulate it around the body).
    Stage IIIC2 Cancer has spread to lymph nodes around the aorta.
    Stage IV Cancer has progressed beyond the pelvis.
    Stage IVA Cancer has advanced to the bladder, bowel wall, and/or inner lining of the rectum.
    Stage IVB The cancer has spread to other areas of the body, such as the abdomen and the omentum (tissue lining the abdomen), and to organs away from the uterus, such as the bones or lungs.
    (Source: National Cancer Institute, American Cancer Society)

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    Call: 800.682.2862

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    Boston, MA 02118

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