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How We Diagnose Endometrial Cancer

  • Testing for endometrial cancer

    Endometrial cancer can be a highly curable cancer, and the treatment of uterine cancer is based on the pathology results. That's why it is important to choose a cancer center with an experienced pathology team, like the Division of Women's and Perinatal Pathology at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC).

    Our Pathology Division is one of only a few clinical services in the world with a team of pathologists exclusively dedicated to the diagnosis and study of gynecologic cancers. Our pathologists review thousands of diagnoses each year. We house the largest team of gynecology specialists in the world; these highly specialized experts serve as the radar for your entire treatment team. Our pathologists were among the first to identify the early cellular changes that lead to endometrial cancer.

    Many women come to DF/BWCC 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 gynecology team of pathologists, surgeons, medical oncologists, and radiation oncologists.

  • If you would like a second opinion...

    Our diagnostic team provides expert second opinions from our pathologists, including pathology slide reviews for challenging or difficult cases. We are happy to consult with you, your primary care physician or other specialists.

    You may want to consider a second opinion:

    • To confirm your diagnosis
    • For an evaluation of an uncommon presentation
    • For details on the type and stage of cancer
    • To better understand your treatment options
    • To learn if you are eligible for clinical trials

    Phone: 877-442-DFCI or 877-442-3324
    Online: Complete the Appointment Request Form
    If you cannot travel to Boston in person, you can take advantage of our Online Second Opinion service

    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.

    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 does not always appear 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 smear, 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.

    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. The following tests and procedures may be used in the staging process:

    • Removal of the uterus (hysterectomy) may be done to detect a large tumor or determine how far the cancer has spread beyond the endometrium. This option is helpful in both finding the cancer and decreasing the chance of further cancer growth. In some cases, the cancer can be removed at the time of surgery, along with affected organs, or in order to prevent cancer developing in other areas later on.
    • Chest x-ray: X-ray beams, types of energy beams, are passed through the organs and bones inside the chest onto film to create a picture.
    • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. The procedure is similar to having a CT scan, except the MRI does not deliver radiation.
    • CT scan (also known as a CAT scan): A painless procedure that takes a series of detailed x-ray pictures inside the body from different angles. A CT scan is performed very quickly and is a painless test that will examine your pelvis, abdomen, and chest. The results are typically read and reviewed by our radiology team the same day.

    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 and glands 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.
    • 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.