Carl R. Darnall Army Medical Center - Health Library

Health Library Home>Conditions InDepth>Article

Diagnosis and Prognosis of Uterine (Endometrial) Cancer

Your doctor will ask about your past health. Information about family history of uterine cancer is also important. A physical and pelvic exam will be done. Your doctor may suspect uterine cancer based on your symptoms. The doctor will need to rule out other causes. Tests will be needed to confirm that cancer is present.

Suspicion and Diagnosis of Uterine Cancer

Tests to rule out other conditions and confirm cancer include:

Visual Exams

An ultrasound can measure the thickness of the endometrium. Thicker areas will need further testing. The ultrasound wand may be moved over the belly or inserted into the vagina.

A hysteroscope will let the doctor view the tissue directly. A scope will be passed into the vagina and cervix to the uterus. The scope will have a light and a camera to see the tissue.

Biopsy

A biopsy will confirm cancer. It will also provide other important details about the cancer. An area of suspicious tissue is removed. It will be examined under a microscope. Different biopsy methods include:

  • Endometrial biopsy —A sample of the endometrium is removed. This can be done during a hysteroscope.
  • Dilation and curettage (D&C) —A D&C may be needed if more tissue needs to be removed for testing. Endometrial tissue is scraped from the walls of the uterus.

Staging of Uterine Cancer

Tests will help determine the stage of cancer. Staging is used to identify characteristics of the tumor. This will help to make a treatment plan. Staging will consider how far the original tumor has spread, if lymph nodes are involved, or if cancer has spread. Other details about cancer cells can also be found that will help target the specific cancer.

Surgical Staging

Surgical staging is done with an exploratory laparotomy. An incision is made in the abdominal wall to gain access to the abdominal and pelvic cavities. The areas can be examined for the presence of tumors. For uterine cancer, this may include surgical removal of tumors, tissue, or organs in advance of other staging tests.

Staging Tests

Tests to help with staging may include:

  • Blood tests —markers that indicate cancer may be found in the blood.
  • Imaging tests —to look for tumors and how much tissue is involved. Imaging tests may include:
  • Peritoneal wash—The pelvis and belly cavity is washed with a saline solution. Cells in the wash are collected and examined for the presence of cancer.
  • Cystoscopy—A scope is passed through tube that carries urine out of the body. It can show if cancer has grown into this tube.
  • Sigmoidoscopy—A scope is passed into the lower colon and rectum. It will look for the spread of cancer.

Stages of Uterine Cancer

Uterine cancer is staged from I-IV (1-4):

  • Stage IA —Cancer is in the endometrium AND halfway or less through the muscle layer.
  • Stage IB —Cancer is in the endometrium AND halfway or more through the myometrium.
  • Stage II (2) —Cancer is in the uterus (endometrium and myometrium) AND is in the cervical connective tissue.
  • Stage IIIA (3A) —Cancer is outside the uterus to the outermost layer AND/OR to nearby structures (fallopian tubes, ovaries, or supporting ligaments).
  • Stage IIIB —Cancer is in the vagina OR other connective tissue surrounding the uterus.
  • Stage IIIC —Cancer is in the pelvic lymph nodes outside the uterus AND/OR near the aorta (the body's largest artery).
  • Stage IVA —Cancer is outside the pelvis AND in the bladder AND/OR colon or rectal walls.
  • Stage IVB —Cancer has spread outside the pelvis, and into the abdomen or the lymph and blood streams. Common sites for metastatic uterine cancer are lymph nodes in other parts of the body, the lungs, liver, brain, and bones.

Grading of Uterine Cancer

Uterine cancer can be graded by how cells looks under a microscope. Uterine cancer is grouped as low or high risk.

  • Low risk (grades 1-2)—less aggressive. Least likely to become invasive and spread. Grade 2 tumors are more aggressive than grade 1 tumors.
  • High risk (grade 3)—most aggressive. Most likely to become invasive and spread outside of the uterus.

Grades 1-2 have the best prognosis.

Prognosis

Prognosis is an estimate of the course and/or outcome of a disease or condition. It is most often expressed as the percentage of patients who are expected to survive over 5 or 10 years. Cancer prognosis is not exact, but best estimate with information available.

On average, the 5-year survival rate for uterine cancer is about 81%. Individual rates depend on the stage of the cancer at the time of diagnosis. Uterine cancer found in the earliest stages (stage IA) offer the best chance for a cure. Survival rates can be as high as 90%. Survival rates decrease as cancer stages increase. Women with stage IV uterine cancer have a survival rate around 15%.

REFERENCES:

Cancer stats facts: Endometrial cancer. National Cancer Institute website. Available at: https://seer.cancer.gov/statfacts/html/corp.html. Accessed December 14, 2017.

Endometrial cancer. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T113952/Endometrial-cancer. Updated May 24, 2017. Accessed December 14, 2017.

Endometrial cancer. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/gynecology-and-obstetrics/gynecologic-tumors/endometrial-cancer. Updated March 2017. Accessed December 14, 2017.

Endometrial cancer. The American College of Obstetricians and Gynecologists website. Available at: https://www.acog.org/Patients/FAQs/Endometrial-Cancer. Updated June 2016. Accessed December 14, 2017.

Stages of endometrial cancer. National Cancer Institute website. Available at: https://www.cancer.gov/types/uterine/patient/endometrial-treatment-pdq#section/_111. Updated October 13, 2017. Accessed December 14, 2017.

Tests for endometrial cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/endometrial-cancer/detection-diagnosis-staging/how-diagnosed.html. Updated November 20, 2017. Accessed December 14, 2017.

Last reviewed December 2017 by EBSCO Medical Review Board Mohei Abouzied, MD, FACP  Last Updated: 12/14/2017