Uterine Cancer

Diagnosis

To determine if uterine cancer is present, a Mayo Clinic gynecologist will ask about the patient's medical history and conduct a physical exam. During a pelvic exam the doctor will feel for lumps or abnormalities in the uterus. Ultrasound also helps to diagnose uterine cancer. A transvaginal ultrasound can be used to rule out other conditions. In this procedure, a wand like device (transducer) is inserted into the vagina. Sound waves from the transducer create a video image of the uterus.

Cells can also be removed from the lining of the uterus in an endometrial biopsy, which is performed without anesthesia, or in a dilation and currettage (D&C). D&C involves the scraping of the uterus while the patient is under anesthesia. A pathologist then carefully examines the endometrial cells in a laboratory. Many patients mistakenly believe that a Pap smear can detect uterine cancer.

If cancer of the endometrium or uterine sarcoma is found, the gynecologist will refer the patient to a gynecologic oncologist for care. A majority of endometrial cancer cases are diagnosed while the disease is confined to the uterus.

Endometrial cancer is classified by stage according to the development of the disease. Because surgery is the primary treatment in most cases, the staging is determined through exploratory surgery (laparotomy). The stages of endometrial cancer include:

• Stage I — Cancer cells are confined to the uterus. The stage may be further classified as 1A, 1B, or 1C depending on how deeply the cancer has invaded the uterine (muscle) wall.
• Stage II — Cancer is found in the uterus and the cervix but has not spread outside the uterus. Stage II cancers may be further classified as stage IIA or IIB depending on whether the cancer has invaded the cervical stroma (supportive tissue).
• Stage III — The cancer has spread outside the uterus but not beyond the pelvis. In Stage IIIA, cancer has spread to the serosa (watery membrane) or the adnexa (appendages of the uterus such as the fallopian tubes) or pelvic peritoneal (lining of the pelvis). In stage IIIB, the cancer cells have spread to the vagina. In stage IIIC, cancer has spread to pelvic or paraaortic lymph nodes.
• Stage IV — The cancer has spread beyond the pelvis or has invaded tissue in the bladder or rectum. In stage IVA, the tumor has invaded the bladder or the mucous membrane of the bowel. In stage IVB, cancer has spread to distant sites, including intraabdominal or lymph nodes in the groin.