Diagnosis & staging
These are tests that may be used to diagnose this type of cancer.
- Investigations of abnormal vaginal bleeding may include :
- Physical examination of the pelvic area
- Endometrial biopsy – removal of a small piece of tissue from the uterine lining or endometrium to check for signs of cancer
- D and C (dilation and curettage) is a procedure used to collect tissue samples from the uterine lining or endometrium. In this procedure, the opening of the cervix is enlarged (dilated) and a special instrument is used to sample the tissue on the inside of the uterus
- If a cancer is strongly suspected, a surgeon may do a hysterectomy (the surgical removal of the uterus) and surgical staging (removal of the ovaries, fallopian tubes, and lymph nodes that drain the uterus) to check if there is any spread of the cancer.
- Imaging such as x-rays or ultrasound, and possibly blood tests at a lab, may also be done.
For more information on tests used to diagnose cancer, see our Recommended Websites, Diagnostic Tests
Types and Stages
Endometrial cancer (adenocarcinoma or carcinoma)
- This cancer develops in the glands of the endometrium.
Subtypes of endometrial cancer include:
Endometrioid endometrial cancer
- Endometrioid is the most common subtype of endometrial cancer. It occurs in 70-80% of cases.
- It is confined to the uterus in approximately 85% of cases (i.e.,stage I with no distant spread).
- The cure rate is very high.
Serous and clear cell endometrial cancers
- Serous and clear cell endometrial cancers are rare, more aggressive subtypes of endometrial cancer.
- They usually require additional therapy following surgical staging.
- Adenocarcinoma is a common sub-type of endometrial cancer.
- It is usually discovered in early stages.
- If the cancer is found in stage 1, the cure rate is very high.
- Sarcomas are tumours that start in the muscle or connective tissue that support the uterus.
- This is an uncommon type of uterine cancer.
- Sarcomas can be fast growing. Patterns of spread depend on the subtype.
Subtypes of uterine sarcomas include:
- Leiomyosarcoma accounts for about one third of all uterine sarcomas.
- Leiomyosarcomas develop in the myometrium or muscular wall of the uterus.
- Spread can be distant (for example, to the lungs).
Endometrial stromal sarcoma (ESS)
- This is a rare subtype which can be low or high grade.
- Low grade ESS often does not require any additional therapy or can be managed with hormones only.
Malignant Mixed Mullerian Tumour (MMMT or carcinosarcoma)
- Contain both glandular cells from the endometrial lining (carcinoma component) and appear to contain muscle-derived cells (sarcoma component).
- Usually treated as an aggressive form of endometrial carcinoma, using the same surgical, chemotherapy and radiation guidelines.
- Trophoblastic tumours are uncommon malignant tumours of the tissues that become the placenta.
- The tumours may start during pregnancy, causing a miscarriage, or may start after delivery.
- The tumours can grow very quickly and may spread to the lungs.
- There is a high incidence in China, Mexico and the Philippines.
- Protein deficiency, malnutrition and multiple pregnancies are risk factors.
- These cancers are usually curable.
- Subtypes: Hydatidiform mole and choriocarcinoma
Staging describes the extent of a cancer. The TNM
classification system is used as the standard around the world. In general a lower number in each category means a better prognosis. The stage of the cancer is used to plan the treatment.
T describes the site and size of the main tumour (primary)
N describes involvement of lymph nodes
M relates to whether the cancer has spread (presence or absence of distant metastases)
Tumour confined to the corpus uteri
None or less than half myometrial invasion
Invasion ≥ half of the myometrium
Invades into cervical stroma
Local and/or regional spread as specified in IIIA, B, C
Tumour involves serosa of corpus uteri or adnexae
Vaginal or parametrial involvement or pelvic peritoneum
metastases to the pelvic and/or para-aortic lymph nodes
Positive pelvic nodes
Positive para-aortic nodes
Tumour invades bladder mucosa and/or bowel mucosa
Some types of tumours are assigned a grade based on the appearance of the tumour cells and their rate of growth.
Lower grade cancer cells are usually slow growing, and under a microscope appear almost normal.
Higher grade cancer cells grow quickly, cell appearance is very different from normal cells, and they invade aggressively into surrounding tissue.