Accurate diagnosis should:
• Differentiate endometrial cancer from other possible diseases
• Identify the particular cancer type
• Evaluate if the disease has spread.

Because benign conditions — fibroid tumors, endometrial hyperplasia, and the start of normal menopause — all produce symptoms similar to several types of uterine cancer, an accurate diagnosis is important.

The Examination

The physician will conduct a pelvic exam to determine the source of the bleeding and evaluate the uterus, ovaries, fallopian tubes, vagina, bladder, and rectum. Occasionally, the doctor may use ultrasound to view the inside of the uterus.

Taking a Biopsy

A sample of endometrial tissue to check for abnormal cells is the key to a definitive diagnosis. This procedure of removing and examining tissue is called an endometrial biopsy. An endometrial biopsy, usually performed with a small plastic aspiration catheter (tube), is done during a pelvic exam in your physician’s office.

Occasionally, there maybe a reason that the biopsy cannot be obtained in this way, so an additional procedure called a dilation and curettage, usually referred to as a D&C, is performed. In this procedure, the uterus is scraped or tissue is snipped out while the woman is under anesthesia. If necessary, at this same time, the physician may do an additional procedure called a diagnostic hysteroscopy in which an optical instrument is inserted into the uterus to view the entire cavity and the surface of the endometrium.

Using this instrument, the doctor can also select specific tissue for removal and analysis. In the majority of cases though, a biopsy in your physician’s office is the only procedure needed to obtain an accurate diagnosis.

Examining the Tissue

Once a biopsy is obtained, a pathologist examines the cellular makeup of the tissue to determine if it contains cancerous cells.

The pathologist determines what type of cancer cells are present and the stage of development. The less defined each cell and the more the cancer looks like a solid mass of cells instead of normal endometrial cells, the more aggressive the cancer is likely to be. This is called the grade of the tumor. The pathologist will give the tumor a grade of 1, 2, or 3. Grade 1 tumor cells look more like normal endometrial cells, while grade 3 tumor cells look less like normal endometrial cells.

Other Tests

Additional testing sometimes is needed after the biopsy. Prior to surgery, the doctor may decide to measure the size, location, and density of tumors with computed axial tomography, or CAT scan often called a CT scan. It can also show if the cancer has spread beyond the uterus into the pelvic lymph nodes. Intravenous pyelography (IVP), a type of x-ray locates growths in the urinary tract. A magnetic resonance imaging or MRI study shows cross-sectional images of internal organs.

In addition, the tumor cells may be tested to determine their ability to accept progestin. If the cancer is due to over stimulation by estrogen, taking opposing progestin may become part of the treatment. From these diagnostic procedures, you and your doctor can tailor a treatment plan to suit you and your disease.

Stages Of Development
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The decision about how to treat any invasive cancer is based on how much tissue the cancer has penetrated. A classification system, also called staging, is used to describe how far cancer has spread.

Endometrial cancer can progress through five stages, from tissue abnormalities like hyperplasia to metastatic cancer that has spread to the bladder, bowel, or other parts of the body. The cancer can spread to the muscular tissues in the wall of the uterus (called the myometrium), the cervix and vagina, the nearby lymph nodes, the bladder, the bowel, the abdominal cavity, and even more distant organs and lymph nodes. Cancer can also spread to distant areas of the body through the lymphatic system (the network of glands and vessels throughout the body that make up part of the immune system).

Except for hyperplasia, which is staged by biopsy, all cancers of the uterus can only be staged at the time of hysterectomy — surgery to remove the uterus, fallopian tubes, ovaries, and often the pelvic and paraaortic lymph nodes. The grade of the cancer is also determined at that time. The stage and the grade of the cancer will help determine what further treatment your physician will recommend.

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