Endometrial Cancer:
Diagnosis and Staging

This page covers tests that are often used to help diagnose and stage endometrial cancer.
Depending on the symptoms you have, you may also be asked to undergo other tests and investigations.

“Hope is grief’s best music.”

Marco Calderon

Diagnostic Tests to Determine Cancer Type

Once the doctor is sure of an abnormality, diagnostic tests are done to determine further details about the type of cancer present.

Hysteroscopy

What to expect

This test helps your doctor to visually examine the inside of your uterus and the vaginallining for any abnormalities.This test is generally performed using a local anaesthetic (numbing medicine). Due to the anaesthetic, you will generally be pain-free. You can expect some minor discomfort while
undergoing the test.It is important that you choose a doctor and clinical team that you are comfortable with to perform your check-up.

During the procedure:

  • You will first be asked to undress the lower part of your body and lie on your back on the examination table. Ask for a sheet or blanket to cover yourselfwhile you wait for your doctor.
  • Try to relax your pelvic area, as this will make the exam more comfortable for you.
  • The doctor will start by administering the local anaesthetic to numb the area.
  • Next, your doctor will insert a thin, flexible tube with a light source (called a hysteroscope) through your vagina and cervix, into your uterus.
  • To get a better view of the inside (lining) of the uterus, the uterus is filled with salt water (saline).

Biopsy

What to expect

A biopsy is usually the best way to tell for certain if an abnormal area is cancerous or not and is usually done immediately after the hysteroscopy. This procedure involves collecting a sample of endometrial tissue for further analysis in a lab. 

During this procedure, your doctor will draw some cells from the endometrial lining into a tube using gentle suction. You might feel some period-like cramps while it is being done, but they usually wear off in a few minutes. After the test, you may have light bleeding and some mild period-like discomfort for a couple of days.

Dilation & curettage (D&C)

What to expect

A procedure called dilation & curettage (D&C) may become essential, if adequate tissue cannot be obtained during a biopsy or if the results of a biopsy are unclear. This procedure involves scraping of tissue from the lining of your uterus, which is then examined under a microscope to check for cancer cells.

  • During this procedure: You will be placed under a general anaesthetic
  • The doctor will stretch (dilate) your cervix to open it, and use a hysteroscope to examine the uterus
  • The doctor will then use a small instrument (called a curette) to carefully remove tissue from the vaginal lining

After the procedure, you may have period-like pains and some vaginal bleeding, which can last for a few days.

Diagnostic Tests to Determine
Stage and Spread of Cancer

Bone Scan

What to expect

A bone scan is a type of imaging study and is generally painless. During the scan, an image of the bones is taken. It is typically more sensitive than an X-ray. It is important that you choose a doctor and clinical team that you are comfortable with to perform scan.

You may be asked to refrain from eating or drinking for a few hours before your scan. Be sure to inform your doctor prior to your scan if

You are pregnant or breastfeeding

You have previously had an allergic
reaction to contrast material

You are taking any vitamins, ayurvedic
medicines or homeopathic medicines

During a bone scan:

You may be asked to change into a hospital gown and remove your jewellery, watch, body piercings or any other accessory that contains metal. You may also be asked to empty your bladder.

You may be given a special dye (called contrast material) which can help highlight the bones of your body. The dye is typically administered by injection through a vein in your arm. You may need to wait for a few hours for your body to absorb the dye. Your doctor may ask you to drink plenty of fluids while you wait.

Next, a nurse or technician will take you to the room which contains the bone scanner. You will be asked to lie on a narrow table. The nursing staff may use straps to keep you in position. You can ask for a pillow if you are feeling uncomfortable. You will be asked to remain still for the duration of the scan.

During the scan, a device that has a sensitive camera will pass back and forth over your body.

The technicians will be seated in a separate room, but they will be able to see and hear you. You may be asked to communicate with them via intercom. They may ask you to hold your breath at certain times to improve image quality.

The scan will usually take 30 minutes to an hour to complete.

After the scan, you may receive special instructions regarding the contrast material. For example, your technician or doctor may ask you to wait for a few minutes to ensure that you do not have an allergic reaction. You may also be told to drink plenty of fluids to help your kidneys flush out the contrast material through your urine.

CT Scan

What to expect

A CT (computerized tomography) scan is an imaging study and is generally painless. It uses X-rays to take multiple images of the body from different angles to recreate three-dimensional pictures of your internal organs on a computer. It is important that you choose a doctor and clinical team that you are comfortable with to perform your CT scan.

You may be asked to refrain from eating or drinking for a few hours before your scan. Be sure to inform your doctor prior to your scan if

You are pregnant or breastfeeding

You have any metal or electronic
devices implanted in your body (such
as a pacemaker or metal pins)

You are afraid of enclosed spaces
(claustrophobic)

You have previously had an allergic
reaction to contrast material

You are taking any vitamins, ayurvedic
medicines or homeopathic medicines

During a CT scan

You may be asked to change into a hospital gown and remove your jewellery, watch, body piercings or any other accessory that contains metal. You may also be asked to empty your bladder.

You may be given a special dye (called contrast material) which can help highlight the areas of your body that are being examined. The dye can be given to you by mouth (in a drink), by injection through a vein in your arm or by an enema in your rectum. You may need to wait for 30 minutes to an hour for your body to absorb the dye.

Next, a nurse or technician will take you to the room which contains the CT scanner. You will be asked to lie on a narrow, motorized table that will slide you into the machine. The nursing staff may use straps to keep you in position. You can ask for a pillow if you are feeling uncomfortable. You will be asked to remain still for the duration of the scan.

As the table moves you into the CT scanner, various detectors and X-ray tubes will rotate around you. Each rotation will produce several cross-section images of your body. You may hear some buzzing or whirring noises – try not to be alarmed and remember to stay still.

The technicians will be seated in a separate room, but they will be able to see and hear you. You may be asked to communicate with them via intercom. They may ask you to hold your breath at certain times to improve image quality.

The scan will usually take 20-30 minutes to complete.

After the scan, you may receive special instructions regarding the contrast material. For example, your technician or doctor may ask you to wait for a few minutes to ensure that you do not have an allergic reaction. You may also be told to drink plenty of fluids to help your kidneys to flush out the contrast material through your urine.

MRI Scan

What to expect

Magnetic resonance imaging (MRI) scan is a procedure in which an MRI scanner uses a high-powered magnet and a computer for comprehensive images of the internal organs and surrounding structures. MRI scans normally add supplementary information about cervical anomalies and may be recommended only in select cases. The scan is generally painless. It is important that you choose a doctor and clinical team that you are comfortable with to perform your MRI scan.

You may be asked to refrain from eating or drinking for a few hours before your scan. Be sure to inform your doctor prior to your scan if:

You are pregnant or breastfeeding

You have any metal or electronic
devices implanted in your body (such
as a pacemaker or metal pins)

You are afraid of enclosed spaces
(claustrophobic)

You have previously had an allergic
reaction to contrast material

You are taking any vitamins, ayurvedic
medicines or homeopathic medicines

During a MRI scan:

You may be asked to change into a hospital gown and remove your jewellery, watch, body piercings or any other accessory that contains metal. You may also be asked to empty your bladder.

You may be given a special dye (called contrast material) which can help highlight the areas of your body that are being examined. The dye is typically administered by injection through a vein in your arm. You may need to wait for 30 minutes to an hour for your body to absorb the dye.

Next, a nurse or technician will take you to the room which contains the MRI machine. You will be asked to lie on a narrow, motorized table that will slide you into the machine. The nursing staff may use straps to keep you in position. You can ask for a pillow if you are feeling uncomfortable. You will be asked to remain still for the duration of the scan.

As the table moves you into the MRI machine, the machine creates a strong magnetic field around you and radio waves are directed at your body. You may hear repetitive noises such as thumping or tapping – try not to be alarmed and remember to stay still. You can request earplugs or have music playing to help you block out the noise.

The technicians will be seated in a separate room, but they will be able to see and hear you. You may be asked to communicate with them via intercom.

The scan will usually take about 30 minutes to an hour to complete.

After the scan, you may receive special instructions regarding the contrast material. For example, your technician or doctor may ask you to wait for a few minutes to ensure that you do not have an allergic reaction. You may also be told to drink plenty of fluids to help your kidneys to flush out the contrast material through your urine.

PET Scan

What to expect

PET (Positron emission tomography) scan is a process that uses radioactive glucose to detect malignant tumour cells in the body. Malignant tumour cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. The scan is generally painless. It is important that you choose a doctor and clinical team that you are comfortable with to perform your PET scan. Some hospitals have a combined PET/CT scanner.

You may be asked to refrain from eating or drinking for a few hours before your scan. Be sure to inform your doctor prior to your scan if:

You are pregnant or breastfeeding

You have any metal or electronic
devices implanted in your body (such
as a pacemaker or metal pins)

You are afraid of enclosed spaces
(claustrophobic)

You have previously had an allergic
reaction to contrast material

You are taking any vitamins, ayurvedic
medicines or homeopathic medicines

During a PET scan:

You may be asked to change into a hospital gown and remove your jewellery, watch, body piercings or any other accessory that contains metal. You may also be asked to empty your bladder.

You may be given a special dye (called contrast material) which can help highlight the areas of your body that are being examined. The dye can be given to you by mouth (in a drink), by injection through a vein in your arm or by an enema in your rectum. You may need to wait for 30 minutes to an hour for your body to absorb the dye.

Next, a nurse or technician will take you to the room which contains the PET scanner. You will be asked to lie on a narrow, motorized table that will slide you into the scanner. The nursing staff may use straps to keep you in position. You can ask for a pillow if you are feeling uncomfortable. You will be asked to remain still for the duration of the scan.

As the table moves you into the PET scanner, the machine will begin to rotate around you. Each rotation will produce several cross-section images of your body. You may hear some buzzing or whirring noises – try not to be alarmed and remember to stay still.

The technicians will be seated in a separate room, but they will be able to see and hear you. You may be asked to communicate with them via intercom.

The scan will usually take about 30 minutes to an hour to complete.

After the scan, you may receive special instructions regarding the contrast material. For example, your technician or doctor may ask you to wait for a few minutes to ensure that you do not have an allergic reaction. You may also be told to drink plenty of fluids to help your kidneys to flush out the contrast material through your urine.

How endometrial cancer is staged

The results of your diagnostic tests will help your doctor determine the size and position of the cancer, and whether it has spread. This is called staging. Knowing the stage and grade of your cancer will help your doctor plan the best course of treatment for you. Typically, the number staging system is used for describing the stage of endometrial cancer.

THE NUMBER STAGING SYSTEM

Endometrial cancer is divided into four number stages.

Stage I endometrial cancer is when cancer cells are only in the uterus. Stage 1cancers are further divided into stages 1A and 1B, depending on the size of thetumour and the deepest point of tumour invasion.

Stage II endometrial cancer is when cancer cells are in the connective tissue of thecervix, but has not spread outside the uterus.

Stage III endometrial cancer is when cancer cells have spread beyond the uterus andcervix, but have not spread outside the pelvis. Stage 3 endometrial cancers arefurther divided into stages 3A, 3B and 3C depending on the size of the tumour andhow far the cancer has spread.

Stage IV endometrial cancer is also called metastatic endometrial cancer. This iswhen the cancer has spread from the pelvic area to other parts of the body, such as the bladder, bowel, bones, liver or lungs.

Endometrial cancer is when cancer cells are only in the uterus. Stage 1 cancers are further divided into stages 1A and 1B, depending on the size of the tumour and the deepest point of tumour invasion.

Treatments for endometrial cancer

Treatment for endometrial cancer depends on several factors, like the type and stage of your cancer, or other health problems you may have. Surgery, chemotherapy, radiation, or a combination of all three may be used. Refer to this section to understand the types of cancer treatments and their effects. Read more

Your cancer journey

Everyone deals with a cancer diagnosis and treatment in a different way. Refer to this section to understand
various aspects of your cancer journey and the road to recovery. Read more

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