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Endometrial Cancer (cont.)

Exams and Tests

If a woman is having abnormal vaginal bleeding or other symptoms, the evaluation starts with a detailed interview. A health care provider asks questions about the woman's symptoms, her medical history and any current conditions, her family's medical history, her menstrual and pregnancy history, and her habits and lifestyle. This information helps the health care provider determine the cause of the symptoms. The interview is followed by a physical examination, including a pelvic examination.

If a health care provider suspects uterine cancer, he or she refers the woman to a specialist in cancers of the female genital tract (gynecologic oncologist).

Lab tests

No blood or imaging studies can confirm the diagnosis of endometrial carcinoma. Lab tests may be performed after endometrial cancer is diagnosed to ensure that a woman is able to undergo treatment and also to monitor treatment progress.

Tumor markers: A woman's blood may be checked for a tumor marker known as CA 125. This marker is commonly elevated in patients with ovarian cancer; however, this marker is nonspecific for endometrial cancer. CA 125 is released into the bloodstream by some ovarian and uterine tumors. A very high level of CA 125 sometimes indicates that a cancer has spread from the endometrium to other parts of the body. If a woman's blood has a high level of CA 125 at the time that her cancer is diagnosed, this marker will be checked periodically as a measure of how well the treatment is working. For example, after the uterus and tumor are surgically removed, the tumor marker level may decrease dramatically.
Routine blood tests: Tests of blood chemistry, liver and kidney functions, and blood cell counts are done to check a woman's overall health and her ability to tolerate surgery and other therapy.

Imaging studies

In many instances, imaging studies are not necessary but if performed may include the following:

Vaginal (transvaginal) ultrasound: Ultrasound is a technique that uses sound waves to take a picture of the internal organs. Ultrasound is the same technique used to look at a fetus in the uterus. To perform a vaginal (transvaginal) ultrasound, a small device called a transducer is inserted into the vagina. The device emits sound waves, which bounce off the pelvic organs and transmit a picture to a video monitor. Often, the examiner moves the transducer around slightly to get a better picture. A vaginal (transvaginal) ultrasound is safe and painless.
Hydroultrasound: Hydroultrasound is similar to vaginal (transvaginal) ultrasound, but a saline (salt water) solution is first injected into the uterus to extend the uterine walls. This procedure can improve the picture in some cases and show the uterus in greater detail.

Ultrasound often can reveal a uterine tumor, but the findings are not always conclusive. Other imaging tests may be needed and might include the following:

A CT scan of the pelvis would be the usual choice of a follow-up imaging test. A CT scan is like an x-ray film but shows greater detail in 2 dimensions.
An MRI of the pelvis is another choice of a follow-up imaging test. An MRI shows great detail in 3 dimensions.
A chest x-ray may be needed if metastasis to the lungs is suspected.
A bone scan may be needed if metastasis to the bones is suspected.

Diagnostic tests

Diagnostic tests that can aid in identifying endometrial cancer include the following:

Endometrial biopsy: If cancer is suspected, a sample of the endometrium is obtained through a biopsy. A biopsy is the removal of a very tiny piece of tissue from the body. The tissue is examined under a microscope for abnormalities that suggest cancer. Usually, a gynecologist or a gynecologic oncologist performs the biopsy, and the endometrial tissue is examined by a pathologist (a doctor who specializes in diagnosing diseases in this way). The most widely used method for obtaining the endometrial tissue is to insert a thin tube into the endometrium through the cervix. A biopsy is usually performed in the doctor's office and takes just a few minutes. Often, the results of an endometrial biopsy give a definitive answer about cancer.

Dilation and curettage: If the results of the endometrial biopsy are not conclusive, a procedure called a dilation and curettage (D&C) may be performed. In a D&C, the doctor passes a thin instrument through the dilated cervix and scrapes tissue from the endometrium. The tissue is removed and examined by a pathologist. This procedure is usually performed as outpatient surgery and requires general anesthesia or sedation. Most women have minimal discomfort after this procedure and require a short recovery time.
Hysteroscopy: Sometimes, an endoscope is used to guide the endometrial biopsy or D&C. An endoscope is a thin tube with a tiny light and camera at the end. The tube is inserted into the uterus through the cervix. The endoscope sends pictures of the endometrium back to a video monitor. A hysteroscopy allows the doctor to view the inside of the uterus while collecting endometrial tissue samples.

Staging

Staging is a system for classifying cancers based on the extent of the disease. In general, the lower the cancer stage, the better the outlook for remission and survival. (Remission is when no evidence of cancer is found in the body.) Health care providers cannot make recommendations for the best treatment until they know the exact stage of cancer.

In endometrial cancer, staging is based on how far the primary tumor has spread, if at all. The staging system used for endometrial cancer was developed by the International Federation of Gynecology and Obstetrics (FIGO). The staging system for endometrial cancer is a surgical staging system, meaning that staging is based on the pathologist's findings on examining organs removed during surgery. The FIGO system uses 4 stages.

Stage I: The tumor is limited to the corpus (upper part) of the uterus and has not spread to the surrounding lymph nodes or other organs.

Stage IA - Tumor limited to the endometrium
Stage IB - Invasion to less than one half the myometrium
Stage IC - Invasion to more than one half the myometrium

Stage II: The tumor has spread from the corpus of the uterus to the uterine cervix but has not spread to the lymph nodes or other organs.

Stage IIA - Involvement of only glandular tissue lining the cervix
Stage IIB - Invasion of the cervical stroma (strong supportive connective tissue of the cervix)

Stage III: The cancer has spread outside the uterus but is confined to the pelvic area.

Stage IIIA - Invasion of the serosa (outermost layer of the myometrium) and/or the adnexa (the ovaries or fallopian tubes) and/or cancer cells are found in the peritoneal cavity
Stage IIIB - Invasion of the vagina but not to the lymph nodes or other organs
Stage IIIC - Cancer has spread to the lymph nodes but not to distant organs

Stage IV: The cancer has spread to the inside (mucosa) of the bladder or the rectum (lower part of the large intestine) and/or to the lymph nodes and/or to the bones or distant organs outside the pelvis, such as the lungs.

Stage IVA - Tumor invasion of the bladder, the bowel mucosa, or both
Stage IVB - Metastasis to distant organs, including intra-abdominal metastasis, inguinal lymph nodes, or both

The tumor grade is also defined during the staging process. Grade indicates the aggressiveness of the cancer. Generally, low-grade tumors are less likely to metastasize or recur after treatment.