Endometrial & Other Uterine Cancers: Diagnosis & Staging

Your Memorial Sloan Kettering doctors will arrange for review of your pathology slides and imaging tests to make an accurate diagnosis and generate a treatment plan. Many women come to Memorial Sloan Kettering because they have received a diagnosis of uterine cancer after experiencing abnormal menstrual bleeding and are looking for a second opinion.

At your first appointment with us, our doctors will perform a comprehensive physical examination, including a pelvic exam. Depending on these results, we may also perform imaging and other diagnostic tests, including computed tomography (CT) scanning, magnetic resonance imaging (MRI), and/or positron emission tomography (PET) imaging.

Biopsy

If it appears that uterine cancer might be present, we will perform an endometrial biopsy to take a sample of tissue from the inner lining of the uterus (the endometrium) if this has not already been done by another doctor. In this procedure, a thin, flexible tube is inserted through the cervix into the uterus, and gentle scraping and suction are used to remove a tissue sample. The sample is then sent to our pathologists to examine under a microscope.

Your doctors may also perform a hysteroscopy to examine the inside of the uterus, during which a hysteroscope — a thin, lighted tube with a video camera on its tip — is inserted through the cervix and into the uterus, and tissue may be taken for biopsy.

Dilation & Curettage

If a diagnosis is not clear after preliminary tests, you may need to have an outpatient surgical procedure called dilation and curettage (D&C).

During this procedure, the doctor widens the cervix and gently scrapes tissue from inside the uterus. A D&C may require general anesthesia or conscious sedation, in which you take medication to lessen discomfort and anxiety without putting you to sleep. The procedure generally takes about an hour.

Once a sample of uterine tissue is obtained, the cells will be analyzed to determine whether cancer is present. The cells may also be tested to see if they contain hormone receptors that may help slow the growth of cancer cells. For example, uterine cancers that contain receptors for progesterone tend to grow and spread more slowly than cancers without these receptors.

Staging

The International Federation of Gynecology and Obstetrics (FIGO) classifies endometrial cancer into four stages: cancer that is confined to the uterus (stage 1); or cancer that has spread to the cervix (stage 2);  the vagina, ovaries, and/or lymph nodes (stage 3); or the urinary bladder, rectum, or organs located far from the uterus, such as the lungs or bones (stage 4).

The majority of women with uterine cancer are diagnosed at an early stage, when the cancer is still limited to the uterus (68 percent). Twenty percent are diagnosed when the cancer has metastasized (spread) to nearby organs and lymph nodes, and eight percent are diagnosed when it has metastasized to distant parts of the body.