Diagnosis & staging
The uterus is part of the reproductive system. It is sometimes called the womb. It is the part of the body in which a baby grows during pregnancy.
The uterus is a hollow organ the size and shape of an upside-down pear. It is in the pelvis between the bladder and rectum.
The upper part of the uterus is called the fundus or dome. The central part of the uterus is called the body or corpus.
The lower part, or neck, of the uterus is called the cervix. It is the connection between the body of the uterus and the vagina. Cervical Cancer Information
- The myometrium is the muscular, outer layer. It is needed to push out a baby during birth.
- The endometrium is the inner layer or lining. During a person's menstrual cycle, hormones cause the endometrium to change. Ovaries make estrogens which cause the endometrium to thicken. This is needed for pregnancy. If there is no pregnancy, a change in hormones causes the endometrium to shed. This causes bleeding during a person's menstrual period.
Endometrial cancer is the most common type of uterine cancer.
Cancers that start in the muscle or connective tissue in or near the uterus are much less common. These are called uterine sarcomas.
Endometriosis is a condition in which tissue that looks like the uterine lining grows in areas it should not grow in the pelvic area. It is not cancer.
These are some of the symptoms of uterine / endometrial cancer:
- Unusual vaginal bleeding is the most common symptom, such as:
- Bleeding between periods.
- Bleeding with sexual intercourse.
- Heavy bleeding (more than is normal for you).
- Irregular or heavy bleeding during menopause or any bleeding after menopause.
- Unusual vaginal discharge.
- Difficult or painful urination (peeing).
- Pain in the abdomen or pelvic area.
- Back pain.
Investigating early symptoms usually leads to an early diagnosis and successful treatment.
If you have any signs or symptoms that you are worried about, please talk to your family doctor or nurse practitioner.
Tests that may help diagnose uterine or endometrial cancer include:
- Physical exam: a doctor or nurse practitioner will do a pelvic or rectal exam. This involves them putting their fingers inside your vagina or rectum (bum). They may also feel your abdomen and groin to look for fluid build-up or swollen lymph nodes.
- Biopsy: a small amount of tissue is removed from the endometrium. A specialist (pathologist) will examine the tissue to check for cancer.
- D and C (dilation and curettage): the opening of your cervix is made larger (dilated) and a special instrument removes tissue samples from your endometrium. This is done in an operating room. You may have general anesthesia (put under) or sedation (medication that helps you relax and may make your sleepy). You may also have local anesthesia which will numb the area for the procedure. This may be done if the sample from an endometrial biopsy was too small or the biopsy results were unclear.
- If your doctor suspects you have cancer, a surgeon may do a hysterectomy (remove your uterus). A surgeon may also remove your ovaries, fallopian tubes and lymph nodes near your uterus to check if the cancer has spread.
- Imaging: x-rays or ultrasound to see the tumour and if it has spread to other tissues.
- Blood tests: to check if cancer has spread to the liver of kidneys.
- Endometrial carcinoma: Most common. About 70-80% (70-80 out of 100) of endometrial cancers. Usually only in the uterus and has not spread. Cure rate is very high.
- Serous, clear cell and mucinous cancers: Rare and more aggressive.
- These are rare types of uterine cancer. They can grow fast and spread.
Staging describes the cancer. Staging is based on how much cancer is in the body, where it was first diagnosed, if the cancer has spread and where it has spread to.
The stage of the cancer can help your health care team plan your treatment. It can also tell them how your cancer might respond to treatment and the chance that your cancer may come back (recur).
- Stage 1A: Tumour is only in the endometrium or has grown less than halfway through the muscle layer of the uterus wall (myometrium).
- Stage 1B: Tumour has grown halfway or more than halfway into the myometrium.
- Stage 2: Tumour has grown into the cervix.
- Stage 3A: Tumour has grown into the outer surface of the uterus (uterine serosa) or has grown into the fallopian tubes, ovaries or their supporting ligaments.
- Stage 3B: Tumour has grown into or spread to the vagina or tissues next to the cervix and uterus (called the parametria).
- Stage 3C: Cancer has spread to the lymph nodes in the pelvis (pelvic lymph nodes) or to the lymph nodes around the aorta (para-aortic lymph nodes)
- Stage 4A: Tumour has grown into the lining of the bladder or intestines.
- Stage 4B: Cancer has spread to other parts of the body such as the lungs, liver or bone. This is called distant metastases or metastatic cancer.
- Stage 1A: Tumour is only in the uterus. Tumour is not larger than 5 cm (2 inches).
- Stage 1B: Tumour is only in the uterus. Tumour is larger than 5 cm (2 inches).
- Stage 2A: Tumour has grown into the fallopian tubes, ovaries or their supporting ligaments.
- Stage 2B: Tumour has grown into other tissues in the pelvis.
- Stage 3A: Tumour has grown into one part of the abdomen.
- Stage 3B: Tumour has grown into 2 or more parts of the abdomen.
- Stage 3C: Cancer has spread to the lymph nodes in the pelvis (pelvic lymph nodes) or to the lymph nodes around the aorta (para-aortic lymph nodes)
- Stage 4A: Tumour has grown into the lining of the bladder or rectum.
- Stage 4B: Cancer has spread to other parts of the body such as the lungs, liver or bone. This is called distant metastases or metastatic cancer.
For more information about staging, see About Cancer.
The grade of the cancer describes how different the cancer cells look from normal cells and how fast the cancer cells are growing. A pathologist will give the cancer a grade after looking at the cells under a microscope.
Uterine and endometrial cancer can be grade 1, 2 or 3. The lower the number, the lower the grade.
Low grade: cells are abnormal but look a lot like normal cells. Low grade cancers usually grow slowly and are less likely to spread.
High grade: cells are abnormal and do not look like normal cells. High grade cancers usually grow more quickly and are more likely to spread.
The grade of the cancer can help your health care team plan your treatment.