If you have any symptoms related to endometrial cancer, with the most
common being abnormal vaginal bleeding, it is important to visit your
doctor right away and undergo the appropriate testing.endometrial-cancer-diagnosis.jpg

Endometrial Cancer Testing
Initially, your doctor will likely administer a physical exam and a blood test to check for endometrial cancer. One or more of the following tests may also be administered:

  • Pelvic Exam: Your doctor will check your vagina, uterus, and surrounding tissue for any visible changes or lumps.
  • Ultrasound: An ultrasound can be used for a more thorough checkup of the uterus and nearby tissue. An ultrasound works through sound waves that create a clear picture of internal organs. An ultrasound can be used to detect a deeper uterine tumor. For a better picture of the uterus, a transvaginal ultrasound device may also be inserted into the vagina.
  • Biopsy: Tissue in the uterus may be removed to check for cancerous cells. In this procedure, a thin tube will be inserted into the vagina to the uterus and will gently scrape tissue for a sample.

A pelvic exam is the most common type of testing for endometrial cancer and is normally used to detect the disease in its early stages. If cancer is found, further testing is necessary to determine how far the cancer has spread and how aggressive it may be.

Endometrial Cancer Staging

Staging is used to classify how far endometrial cancer has spread throughout the body, if at all. Stages of uterine cancer include:

  • Cancer is found only in the uterus.
  • Cancer is found in the uterus and cervix.
  • Cancer has spread outside of the uterus but is still within the pelvic area. This may include cancer in the lymph nodes of the pelvis and near the aorta in the abdomen.
  • Cancer has spread throughout the body to the bladder, bowel, abdomen, and other organs.

Uterine cancer may be classified as Grade 1, 2, or 3. Grade 1 will be the least aggressive form of cancer, ranging to grade 3 as the most aggressive cancer.
Tumors that have a higher grade will grow much faster than tumors with a lower grade. Tumors that are classified with a higher grade are also more likely to spread throughout the body. Doctors use the grading scale above for endometrial tumors to determine how quickly cancer will spread and to better prescribe treatment options.
To determine if endometrial cancer has spread throughout the body and has progressed to a higher stage or grade, a doctor may use lab testing, such as a Pap test, a chest x-ray, a CT scan, or an MRI. A Pap test will help the doctor determine if cancer cells have spread to the cervix; a chest x-ray will determine if tumors have developed in the chest; a CT scan will check for tumors in the pelvis, abdomen, and chest; and an MRI will provide a clearer picture of the uterus and lymph nodes.
In the majority of cases, surgery will be recommended to determine the stage of endometrial cancer. In surgery, the uterus will be removed so that tissue samples can be taken from the pelvis and abdomen to check for cancer growth.

Tumor extent (T)

T0: No signs of a tumor in the uterus

Tis: Pre-invasive cancer (also called carcinoma in-situ). Cancer cells are only found in the surface layer of cells of the endometrium, without growing into the layers of cells below.

T1: The cancer is only growing in the body of the uterus. It may also be growing into the glands of the cervix, but is not growing into the supporting connective tissue of the cervix.

  • T1a: The cancer is in the endometrium (inner lining of the uterus) and may have grown from the endometrium less than halfway through the underlying muscle layer of the uterus (the myometrium).
  • T1b: The cancer has grown from the endometrium into the myometrium, growing more than halfway through the myometrium. The cancer has not spread beyond the body of the uterus.

T2: The cancer has spread from the body of the uterus and is growing into the supporting connective tissue of the cervix (called the cervical stroma). The cancer has not spread outside of the uterus.

T3: The cancer has spread outside of the uterus, but has not spread to the inner lining of the rectum or urinary bladder.

  • T3a: The cancer has spread to the outer surface of the uterus (called the serosa) and/or to the fallopian tubes or ovaries (the adnexa)
  • T3b: The cancer has spread to the vagina or to the tissues around the uterus (the parametrium).

T4: The cancer has spread to the inner lining of the rectum or urinary bladder (called the mucosa)

Lymph node spread (N)

NX: spread to nearby lymph nodes cannot be assessed

N0: no spread to nearby lymph nodes

N1: cancer has spread to lymph nodes in the pelvis

N2: cancer has spread to lymph nodes along the aorta (peri-aortic lymph nodes)

Distant spread (M)

M0: The cancer has not spread to distant lymph nodes, organs, or tissues

M1: The cancer has spread to distant lymph nodes, the upper abdomen, the omentum, or other organs (such as the lungs or liver)

AJCC stage grouping and FIGO stages

Information about the tumor, lymph nodes, and any cancer spread is then combined to assign the stage of disease. This process is called stage grouping. The stages are described using the number 0 and Roman numerals from I to IV. Some stages are divided into sub-stages indicated by letters and numbers.

Stage 0

Tis, N0, M0: This stage is also known as carcinoma in-situ. Cancer cells are only found in the surface layer of cells of the endometrium, without growing into the layers of cells below. The cancer has not spread to nearby lymph nodes or distant sites. This is a pre-cancerous lesion. This stage is not included in the FIGO staging system.

Stage I

T1, N0, M0: The cancer is only growing in the body of the uterus. It may also be growing into the glands of the cervix, but is not growing into the supporting connective tissue of the cervix. The cancer has not spread to lymph nodes or distant sites.

  • Stage IA (T1a, N0, M0): In this earliest form of stage I, the cancer is in the endometrium (inner lining of the uterus) and may have grown from the endometrium less than halfway through the underlying muscle layer of the uterus (the myometrium). It has not spread to lymph nodes or distant sites.
  • Stage IB (T1b, N0, M0): The cancer has grown from the endometrium into the myometrium, growing more than halfway through the myometrium. The cancer has not spread beyond the body of the uterus.

Stage II

T2, N0, M0: The cancer has spread from the body of the uterus and is growing into the supporting connective tissue of the cervix (called the cervical stroma). The cancer has not spread outside of the uterus. The cancer has not spread to lymph nodes or distant sites.

Stage III

T3, N0, M0: Either the cancer has spread outside of the uterus or into nearby tissues in the pelvic area.

  • Stage IIIA (T3a, N0, M0): The cancer has spread to the outer surface of the uterus (called the serosa) and/or to the fallopian tubes or ovaries (the adnexa). The cancer has not spread to lymph nodes or distant sites.
  • Stage IIIB (T3b, N0, M0): The cancer has spread to the vagina or to the tissues around the uterus (the parametrium). The cancer has not spread to lymph nodes or distant sites.
  • Stage IIIC1 (T1 to T3, N1, M0): The cancer is growing in the body of the uterus. It may have spread to some nearby tissues, but is not growing into the inside of the bladder or rectum. The cancer has spread to pelvic lymph nodes but not to lymph nodes around the aorta or distant sites.
  • Stage IIIC2 (T1 to T3, N2, M0): The cancer is growing in the body of the uterus. It may have spread to some nearby tissues, but is not growing into the inside of the bladder or rectum. The cancer has spread to lymph nodes around the aorta (peri-aortic lymph nodes) but not to distant sites.

Stage IV

The cancer has spread to the inner surface of the urinary bladder or the rectum (lower part of the large intestine), to lymph nodes in the groin, and/or to distant organs, such as the bones, omentum or lungs.

  • Stage IVA (T4, any N, M0): The cancer has spread to the inner lining of the rectum or urinary bladder (called the mucosa). It may or may not have spread to nearby lymph nodes but has not spread to distant sites.
  • Stage IVB (any T, any N, M1): The cancer has spread to distant lymph nodes, the upper abdomen, the omentum, or to organs away from the uterus, such as the bones, omentum, or lungs. The cancer can be any size and it may or may not have spread to lymph nodes.
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Source: "Endometrial cancer - PubMed Health." National Center for Biotechnology Information. N.p., n.d. Web. 10 Oct. 2011.