An endometrial biopsy should be performed if a woman is experiencing any symptoms of uterine cancer. A thin, flexible tube is inserted through the cervix and into the uterus. Using suction, a small amount of endometrial tissue is removed through the tube. A pathologist views the tissue under a microscope to look for abnormal cells and confirms the diagnosis of endometrial cancer.
If the endometrial biopsy does not provide enough tissue or if a cancer diagnosis is not definite, a dilation and curettage (D&C) may be performed. This surgical procedure involves dilating the cervix with a series of increasingly larger metal rods, and then inserting an instrument (curette) to scrape cells from the uterine wall. D&C takes about an hour and is usually done as an outpatient procedure under general anesthesia.
Hysteroscopy is a diagnostic test used to help locate adhesions, abnormal growths and other problems inside the uterus. A thin, telescope-like device with a light (hysteroscope) is inserted into the uterus through the vagina, allowing the doctor to view the inside of the uterus and the openings to the fallopian tubes.
When hysteroscopy is used as part of a surgical procedure, tiny instruments will be inserted through the hysteroscope. Hysteroscopy can be done along with a D&C. The procedure may be done with local, regional or general anesthesia depending upon whether other procedures are being done at the same time.
Staging is used to determine how far advanced the cancer is and to measure progress of the disease. Certain procedures are used in the staging process. A hysterectomy with bilateral salpingo-oophorectomy (removal of the uterus, ovaries and fallopian tubes) and pelvic lymph node dissection will usually be done to determine how far the cancer has spread. After reviewing test results, your doctor will tell you the stage of your cancer and discuss the best treatment options.
Endometrial cancers are staged as follows:
Stage I tumors have a five-year survival rate of 90-95%:
Stage IA: Tumor limited to the endometrium (uterine lining)
Stage IB: Invades the inner half of the myometrium (muscle wall of uterus)
Stage IC: Spreads to outer half of the myometrium
Stage II tumors have a five-year survival rate of 75%:
Stage IIA: Involvement of the cervical glands only
Stage IIB: Tumor invades cervical connective tissue
Stage III tumors have a five-year survival rate of 60%:
Stage IIIA: Tumor spreads to outermost layer of uterus, tissue just beyond the uterus and/or the peritoneum (membrane lining the abdominal cavity)
Stage IIIB: Spreads to vagina
Stage IIIC: Spreads to lymph nodes near the uterus
Stage IV tumors have a five-year survival rate of 15-26%:
Stage IVA: Tumor invades the bladder and/or bowel wall
Stage IVB: Spreads beyond the pelvis, including lymph nodes in the abdomen or groin