Diagnosis and Prognosis of Uterine (Endometrial) Cancer

by Cynthia M. Johnson, MA

The doctor will ask about your symptoms and health history. You will also be asked about your family health history. A physical and pelvic exam will be done. This may be enough to suspect uterine cancer. These tests will be done to confirm the diagnosis:

Endometrial biopsy—A sample of the endometrium is removed to look for signs of cancer
Transvaginal ultrasound—an ultrasound wand is inserted in the vagina to view the endometrium

Staging of Uterine Cancer

Tests will help to identify the stage of cancer. Staging looks at the cancer and whether it has spread. It will look at whether lymph nodes are involved. This will help guide treatment.

Surgical Staging

A laparotomy will be done through an incision in the abdomen. The pelvis will be examined for signs of cancer. Cancerous tumors, tissue, or organs may be taken out.

Staging Tests

Tests that may be done are:

Blood tests to look for signs of cancer
Images to look for tumors and how much the cancer has spread using:
Peritoneal wash—The pelvis and belly cavity are washed with a saline solution. Cells from the wash are tested for signs of cancer.
Cystoscopy—A scope is passed through the 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 (1A) —Cancer is in the endometrium AND halfway or less through the muscle layer.
Stage IB (1B) —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 cervical 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 (3B) —Cancer is in the vagina OR other tissue around the uterus.
Stage IIIC (3C) —Cancer is in the pelvic lymph nodes outside the uterus AND/OR near the aorta (the body's largest artery).
Stage IVA (4A) —Cancer is outside the pelvis AND in the bladder AND/OR colon or rectal walls.
Stage IVB (4B) —Cancer has spread outside the pelvis, and into the abdomen or the lymph and blood streams. Common sites for cancer that has spread 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. It is grouped as low or high risk.

Low risk (grades 1-2)—Least likely to become invasive and spread
High risk (grade 3)—Most likely to become invasive and spread outside of the womb

Prognosis

Prognosis is an estimate of the course and outcome of the cancer. It is often given as a percentage of the people who are expected to survive over 5 or 10 years.

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 [1A]) offer the best chance for a cure. Survival rates can be as high as 90%. Survival rates get lower as cancer stages increase. Women with stage IV (4) uterine cancer have a survival rate of about 15%.

References:

Endometrial cancer. The American College of Obstetricians and Gynecologists website. Available at: https://www.acog.org/Patients/FAQs/Endometrial-Cancer. Updated February 2019. Accessed February 26, 2020.

Endometrial cancer. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/endometrial-cancer. Updated October 21, 2019. Accessed February 26, 2020.

Endometrial cancer. Merck Manual Professional Version website. Available at:
...(Click grey area to select URL)
Updated February 2019. Accessed February 26, 2020.

Fernandez C, Levine E, et al. Predictive value of three-dimensional transvaginal sonography for staging of endometrial neoplasia. Journal of Diagnostic Medical Sonography. 2018;34(6):496-500.

Renaud MC, Le T, et al. Epidemiology and investigations for suspected endometrial cancer. J Obstet Gynaecol Can 2018 Sep;40(9):e703.

Last reviewed November 2019 by EBSCO Medical Review Board Elliot M. Levine, MD, FACOG
Last Updated: 1/26/2021

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