Diagnosing cancer of the uterus

Tests

Your doctor will usually start with a physical examination and ultrasound of the pelvic area, but cancer of the uterus can only be diagnosed by removing a tissue sample for testing (biopsy). Cervical screening tests (formerly called Pap smears or tests) are not used to diagnose this cancer.

Staging and grading

Staging is a way to describe the size of the cancer and whether it has spread to other parts of the body. In some cases, these scans can show if the cancer has spread, but it is often not possible to be sure of the stage until after surgery.

Grading describes how the cancer cells look compared with normal cells and estimates how fast the cancer is likely to grow.

Knowing the stage and grade helps your doctors recommend the best treatment for your situation. The information below shows how endometrial cancers are staged and graded. Uterine sarcomas are staged differently, so discuss this with your doctor.

Stages of endometrial cancers

The 4 stages of endometrial cancers may be divided into sub-stages, such as A, B and C, which indicate increasing amounts of tumour.

• stage 1 (early or localised) - The cancer is found only in the uterus.
• stage 2 (regionalised cancer) - The cancer has spread from the uterus to the cervix.
• stage 3 (regionalised cancer) - The cancer has spread beyond the uterus/cervix to the ovaries, fallopian tubes, vagina, or lymph nodes in the pelvis or abdomen.
• stage 4 (metastatic or advanced cancer) - The cancer has spread further, to the bladder, bowel or rectum, throughout the abdomen, to other parts of the body such as the bones or lung, or to lymph nodes in the groin.

Grades of endometrial cancers

• grade 1 (low grade) – The cancer cells look slightly abnormal and are slow growing.
• grade 2 (moderate grade) – The cancer cells look moderately abnormal and are growing at a moderate rate.
• grade 3 (high grade) – The cancer cells look more abnormal and tend to be faster growing than lower-grade cancers.

Tests after surgery

Cancer of the uterus is often removed with surgery. The removed tissue is sent to a laboratory for further testing to find out more about the type and features of the cancer. Some people may also have genetic tests to help doctors decide if any treatment is needed after surgery.

Pathology assessment

The pathologist will check the sample to assess:

• how deeply the tumour is growing into the uterine wall (myometrial invasion)
• how quickly the cells are growing (grade)
• the type of cells that make up the cancer
• whether any lymph nodes contain cancer cells. 

They will also use special chemicals (called stains) to look for any gene changes in the cancer cells. This is called genomic or molecular testing. The results of these tests help your doctors to work out what types of treatment may be helpful and if further genetic tests may be needed

Genetic tests

For endometrial cancer, the tissue sample may be checked for inherited gene changes. For example, a small number of endometrial cancers are caused by Lynch syndrome. This is linked to an inherited fault in the genes that help the cell’s DNA repair itself (called deficient mismatch repair or dMMR). People with Lynch syndrome are at increased risk of other cancers, so it’s important for you, your family and your doctors to know about this. For more information, visit Lynch syndrome at Cancer Council Victoria.

Also, knowing if the tumour contains a faulty gene will help your treatment team decide if further treatment may be needed after surgery.

Prognosis

Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis with your doctor, but it is not possible for anyone to predict the exact course of the disease. Instead, your doctor can give you an idea about the general outlook for people with the same type and stage of cancer of the uterus.

To work out your prognosis, your doctor will consider test results, the type of cancer of the uterus, the rate and depth of tumour growth, the likelihood of response to treatment, and factors such as your age, level of fitness and medical history.

In general, the earlier cancer of the uterus is diagnosed, the better the prognosis. Most early-stage cancers of the uterus have high survival rates. If cancer is found after it has spread to other parts of the body (advanced cancer), there is a higher chance of the cancer coming back after treatment or continuing to grow.