Women's Health Matters

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Diagnosis

Postmenopausal bleeding or heavy and irregular bleeding are the most common signs of endometrial cancer. Pelvic pain may occur but is very rare. Unusual vaginal discharge and pain during intercourse can also be symptoms of endometrial cancer. Although there are many causes of irregular bleeding and these symptoms are usually the sign of benign conditions, you should visit a gynecologist as soon as possible if you experience these symptoms.

Your gynecologist will review your medical history and do a complete physical exam. Your doctor may first order a transvaginal ultrasound to help rule out other conditions but some kind of biopsy is usually necessary to determine the cause of the bleeding and to ensure that cancer is not present. If endometrial cancer is suspected, your doctor will suggest that a sample of the endometrium be removed for testing.

The Sampling of Endometrial Tissue

To find out whether cancer is present or if the abnormal bleeding is due to some other benign process, such as hyperplasia, some of the endometrial tissue must be removed and examined under a microscope. Tissue can be sampled using an endometrial biopsy, dilation and curettage (D & C) or hysteroscopy.

Endometrial biopsy is an office procedure. The sample of endometrial tissue is obtained by the physician through a very thin suction tube inserted into the uterus, through the cervix. The tube removes a small amount of tissue. The discomfort this causes is similar to that of menstrual cramps.

Dilation and curettage (D & C) is an out-patient hospital procedure. It is used if an inadequate amount of tissue was taken from the biopsy or if a clear diagnosis of cancer cannot be made from the biopsy. The cervix is dilated and a special surgical instrument is used to scrape tissue from inside the uterus. The procedure takes about an hour and requires either a local or general anesthetic. Most women experience little discomfort. This procedure may or may not involve a hysteroscopy.

Hysteroscopy is a procedure that can be performed in a doctor’s office. A doctor uses a tiny telescope with a light on the end to examine the inside of a woman’s uterus. If any abnormalities are found, your doctor will take a biopsy sample. Patients receive a local anesthetic and may experience period-like pain for about a day afterwards.

The Testing of Endometrial Tissue

To determine whether cancer is present, a pathologist examines the tissue samples, removed by biopsy, D & C or hysteroscopy, under the microscope. If cancer is found, it is characterized and graded.

Occasionally, other tests are done before surgical treatment, such as a CA-125 blood test or imaging tests, to determine whether the cancer has spread; however, these tests are not usually done because they are rarely helpful.

The lab report will state whether it is an endometrioid cancer or any of the other types of endometrial cancer.

The Stages of Endometrial Cancer

Staging is used to describe the size of a tumour and whether a patient's cancer has spread. Knowing the stage of your cancer can help you and your doctor choose the treatment that is most appropriate for you. The stage is determined by examining tissue removed during an operation.

The main system used to stage endometrial cancer, which was approved by the International Federation of Gynecology and Obstetrics (FIGO), classifies the cancer as Stage I, Stage II, Stage III or Stage IV.

Stage I: The cancer is limited to the body of the uterus.

IA – tumour limited to the endometrium
IB – tumour invades less than one half of the muscular wall of the uterus
IC – tumour invades the outer half of the muscular wall of the uterus
   

Stage II: The cancer has spread from the body of the uterus to the cervix.

IIA – tumour involves only the mucosal lining of the cervix
IIB – tumour invades into the stroma or underlying wall of the cervix
   

Stage III: The cancer has spread beyond the uterus, but not to the rectum or bladder.

IIIA – tumour spreads to the tissue surrounding or on either side of the uterus, fallopian tubes or ovaries, or the peritoneal washings (done at the time of surgery) are positive for cancer cells
IIIB – tumour extends into the vagina
IIIC – tumour spreads into the pelvic, groin or para-aortic nodes
   

Stage IV: The cancer has spread beyond the pelvis to other parts of the body.

IVA – cancer has spread to the mucosa (inner surface) of the urinary bladder or the rectum
IVB – tumour has spread to liver, lung or bones
   

 

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