Endometrial cancer can be a highly curable cancer, and the treatment is based on the results of surgery and pathology. That's why it is important to choose a cancer center with an experienced multidisciplinary team of experts in gynecologic cancers, like the gynecologic oncology team at Dana-Farber Brigham Cancer Center.
Our Pathology Division is one of only a few clinical services globally with a team of pathologists exclusively dedicated to the diagnosis and study of gynecologic cancers. Our team of gynecology specialists is the largest in the world and reviews thousands of diagnoses each year.
Many people come to Dana-Farber Brigham Cancer Center after consulting with their regular gynecologist about symptoms, such as abnormal discharge or bleeding. Given these symptoms, our team of gynecologic cancer surgeons, working together with pathologists and radiologists, perform a combination of biopsies and imaging tests to check for endometrial cancer. Results for every patient are reviewed by a dedicated team of gynecologic pathologists, surgeons, medical oncologists, and radiation oncologists.
Tests to Diagnose Endometrial Cancer
There is no standard screening test to identify endometrial cancer, so it's important that you maintain regular gynecology evaluations and notify your doctor at the first sign of changes or symptoms such as abnormal bleeding, spotting, or discharge between periods or after menopause.
Most appointments to diagnose endometrial cancer begin with a pelvic exam to check for abnormal areas or lumps around your vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. Exams are generally completed in conjunction with your Pap test, a procedure to collect cells from the surface of the cervix and vagina. Our doctors also carefully review your medical history and familial risk before suggesting further invasive tests.
Endometrial cancer begins inside the uterus, so it infrequently appears in the results of a Pap test. Because of this, Pap tests are not used to screen for endometrial cancer. However, sometimes Pap tests show signs of abnormal cells in the lining of the uterus (endometrium), which can be used to identify the potential presence of endometrial cancer. For this reason, following an abnormal Pap test, a sample of endometrial tissue must be removed and examined for cancer cells. Cancer can be confirmed only by removing a small sample of tissue or cells (biopsy). When symptoms suggest endometrial cancer, the following tests may be used to detect cancer:
- Endometrial biopsy: When a small tissue sample is taken from the inner lining of the uterus. A thin tube is inserted through the cervix into the uterus, and a sample is gently scraped off for examination under a microscope. This is done to see if cancer or other abnormal cells are present.
- Dilatation and curettage: A procedure to remove a small sample of tissue from inside the uterus. The procedure may require general anesthesia to reduce discomfort.
- Transvaginal ultrasound: A procedure in which sound waves are bounced off internal tissues or organs, such as the vagina, uterus, fallopian tubes, and bladder. The wave echoes form a picture of body tissues called a sonogram and may show abnormal endometrial thickening.
Tests to Determine the Stage of Endometrial Cancer
If endometrial cancer is found after examining uterine tissue samples, further tests may be done to see if the cancer cells have spread within the uterus or to other parts of the body. The process used to find out if and how far the cancer has spread beyond the uterus is called staging. Tests and procedures that may be used in the staging process include removal of the uterus (hysterectomy), and biopsies of other sites, chest x-ray, MRI (magnetic resonance imaging), and CT scan.
Stages of Endometrial Cancer
Information from exams and diagnostic tests is used to determine the extent of the tumor, and whether or not the cancer has spread to the lymph nodes or other organs. However, the staging of endometrial cancer is the most important factor in determining a treatment plan.
The stages of endometrial cancer are:
- Stage I indicates cancer in the uterus lining and/or the muscle layer of the uterus only.
- In Stage II, the cancer has spread within the uterus to cervical tissue (but not beyond), or to the stroma where the cervix and uterus meet.
- Stage III indicates the tumor has grown and spread beyond the uterus and cervix, but not beyond the pelvis. Stage III could include spread to surrounding and connective tissues, the fallopian tubes, ovaries, vagina, and lymph nodes near the aorta or in the pelvis.
- Stage IV indicates that the cancer has spread beyond the uterine area and pelvic organs into other parts of the body, such as the abdomen, intestine, and/or lymph nodes in the groin. Some cases may include spread into the liver, lungs, or bones.