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Diagnosis and Prognosis of Uterine (Endometrial) Cancer

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by Wood D
 
The diagnosis and prognosis of uterine cancer includes the following:

Review of Medical History

The doctor will ask about your symptoms and medical history. The most common initial symptom of uterine cancer is abnormal bleeding from the uterus. After menopause, any woman who has bleeding from the vagina should be evaluated for the possibility of uterine cancer. The doctor will inquire about your reproductive history, including the age when you started menstruating, pregnancies, if you are menopausal, and your age at menopause. These factors may provide clues about your exposure to estrogen, a known risk factor for uterine cancer. The doctor may also ask if there is a family history of cancer and what medications you take. The doctor also will likely ask about the following medical conditions linked to an increased risk of the disease:

Physical Exam

The doctor will perform a physical exam, including a pelvic exam. This test is performed in a doctor’s office. You will change into a dressing gown and lie back on the examination table. There will be stirrups at the end of the table where you can rest your feet. As part of the pelvic exam, your external genitalia will be examined for signs of infection or redness. Next, the doctor will slide a speculum into your vagina. This allows the area to be opened slightly. This should not hurt or pinch, but may be uncomfortable. After the doctor is done, the speculum will be removed. The doctor will then place two gloved fingers into your vagina while pressing on your lower abdomen. This identifies the size, shape, and position of your uterus, fallopian tubes, and ovaries. The doctor may then place one finger in your vagina and one finger in your rectum to examine the tissues separating those organs.
You should not feel pain during the exam, but you may feel slight pressure. If you are experiencing pain, tell your doctor. You may have a trace of vaginal bleeding afterwards.

Diagnostic Testing

Endometrial biopsy —During a pelvic exam at the doctor’s office, the doctor will remove a tissue sample from the lining of the uterus. Often, an instrument called a tenaculum is used to grasp the cervix. A flexible, thin, suction instrument is passed through the vagina and inserted into the uterus. Using this biopsy tool, the doctor removes a small sample of endometrial tissue.
This specimen will be sent to the lab where a pathologist will examine it for cancer cells. Most patients report some cramping, pain, tugging, and/or pressure during the biopsy.
Dilation and curettage (D & C) —This is a more thorough surgical procedure, which is often used to obtain a more extensive sample of tissue from the uterine lining. The doctor inserts a series of dilators, each tool slightly thicker than the next, into the vagina to gradually open the tightly contracted cervical muscles and increase the size of the opening to the uterus. A scoop-shaped instrument, called a curette, is inserted and used to scrape the uterine lining and remove tissue through the vagina.
Hysteroscopy —This is a surgical procedure that may be performed in conjunction with a D & C. This procedure allows the doctor to view the inside of the uterus through lens and a camera.
Ultrasonography —This is a method of taking pictures of the inside of the body using echoes from sound waves to create an image. It is frequently used in the initial evaluation of suspected uterine cancer. Transvaginal ultrasonography is performed by placing a probe in the vagina to take pictures of the uterus. Abnormal thickening of the endometrium (lining of the uterus) may be a sign of uterine cancer and is usually further evaluated with a biopsy .

Cytology

Cytology is the study of cells. The cytology of cancer cells differs significantly from normal cells, and physicians use the unique cellular features seen on biopsy samples to determine the diagnosis and assess the prognosis of a cancer.
If cancer is found, the pathologist will examine the cancer cells to determine the type and grade of the cancer. In cancer, the term grade refers to the pattern of growth of the cells and the appearance of the individual cells as they are seen under a microscope. Low grade tumors appear more similar to normal uterine tissue. The less the cells resemble normal uterine tissue, the higher the grade the tumor is assigned.
In general, the lower the tumor grade, the better the prognosis. Tumor type is also important. The most common type of uterine cancer is endometrioid adenocarcinoma. About 5% to 10% of uterine cancers are clear cell or serous carcinomas, which are more aggressive. Tests also may be conducted to check for the presence of progesterone (a female hormone) receptor cells. Endometrial cancers with progesterone receptor cells grow and spread more slowly than cancers without the receptors.

Staging

Staging is the process by which physicians determine the prognosis of a cancer that has already been diagnosed. Staging is essential for making treatment decisions (eg, surgery vs. chemotherapy ). Several features of the cancer are used to arrive at a staging classification, the most common being the size of the original tumor, extent of local invasion, and spread to distant sites (metastasis). Low staging classifications (0-1) imply a favorable prognosis, whereas high staging classifications imply an unfavorable prognosis.
Staging for uterine cancer is usually performed at the time of treatment, for example, during a hysterectomy to remove the uterus. Imaging studies, such as CT scans , may be used to help determine if the cancer has spread
Classification
Stage I —Cancer is limited to the uterus; it has not spread to the cervix. This stage is divided into IA, IB, and IC, depending on how far the disease has spread into the muscles of the uterus.
Stage II —The cancer has spread to the cervix but not beyond the cervix. Stage II is divided into IIA and IIB, depending on how far the disease has spread into the cervix.
Stage III —The cancer has spread beyond the uterus and cervix into the pelvis, but not beyond the pelvis. This stage is divided into three substages:
  • IIIA—The cancer has spread to connective tissue around the uterus, ovaries or fallopian tubes, or there are cancer cells in the fluid in the pelvic cavity.
  • IIIB—The cancer has spread to the vagina.
  • IIIC—The cancer has spread to lymph nodes near the uterus (in the pelvis or around the aorta).
Stage IV — the cancer has spread beyond the pelvis. This stage is subdivided into two stages:
  • IVA—The cancer has spread to the surface of the inner lining of the bladder or rectum.
  • IVB—The cancer has spread to lymph nodes in the abdomen (other than in the groin or around the aorta) or distant organs.
Recurrent uterine cancer refers to cancer that has come back after treatment.

Prognosis

Prognosis is a forecast of the probable course and/or outcome of a disease or condition. Prognosis is most often expressed as the percentage of patients who are expected to survive over five or ten years. Cancer prognosis is a notoriously inexact process. This is because the predictions are based on the experience of large groups of patients suffering from cancers at various stages. Using this information to predict the future of an individual patient is always imperfect and often flawed, but it is the only method available.
Five-year survival rates for uterine cancer are:
Stage I: 90%
Stage II: 70%-85%
Stage III: 50%
Stage IV: 10%-30%
 

References


Abeloff M. Clinical Oncology. 2nd ed. Orlando, FL: Churchill Livingstone, Inc; 2000: 1987-2008.


American Cancer Society website. Available at: http://www.cancer.org/ .


Bast R, Kufe D, Pollock R, et al, eds. Cancer Medicine. 5th ed. Hamilton, Ontario: BC Decker Inc; 2000.


National Cancer Institute website. Available at: http://www.nci.nih.gov/ .


Rakel R. Bope E, ed. Conn's Current Therapy. 54th ed. St. Louis, MO: WB Saunders; 2002: 1094-1096.

 

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