Diagnosing Uterine Cancer

Detecting uterine cancer early significantly improves treatment outcomes, with cure rates exceeding 90% at the early stage. In postmenopausal women, this cancer often shows up with obvious symptoms. By familiarizing yourself with diagnostic methods like imaging and biopsy techniques, you can communicate more effectively with your healthcare team. This information aids proactive health management and can reduce anxiety.

Doctors may discover uterine cancer through various circumstances. It could be through suspicious symptoms, such as vaginal bleeding after menopause, or an accidental finding during a routine health examination, such as endometrial cancer cells on a Pap smear. Surgery being performed in the pelvis or lower abdomen for some other reason may also reveal the cancer unexpectedly.

Abnormal vaginal bleeding is the most common sign of uterine cancer, occurring in 75–90% of cases. For women who have gone through menopause and no longer experience a monthly menstrual cycle, any amount of bleeding is considered abnormal and should prompt a doctor’s examination.

For younger individuals (under 55 years old) who have not gone through menopause, abnormal bleeding may include:

• Bleeding between menstrual cycles
• Bleeding after intercourse
• Prolonged bleeding
• Heavy bleeding

It's important to note that in many cases, abnormal bleeding can be attributed to non-cancerous conditions. If you suspect symptoms that might be uterine cancer, talk to your doctor. Your doctor may ask about your symptoms and medical history. They may perform a pelvic examination to check for abnormalities in your womb and lower abdomen. In advanced cases, the womb may feel enlarged and tender.

The doctor may order a transvaginal ultrasound to visualize the uterus, check for tumors or other abnormalities, and measure the thickness of the endometrial lining. Ultrasound is often the first-line imaging test because it is widely available. It uses sound waves to create live images of the uterus and detect tumors and other structures. The technology is similar to the SONAR technology that submarines use to detect things in the ocean. The procedure begins with the insertion of a lubricated ultrasound probe through your vagina to view the inside of your uterus. The lubrication helps the probe pass into the vagina and sharpens the images on the monitor.

In complex cases, CT (computed tomography) or MRI (magnetic resonance imaging) may be used to evaluate the uterus and assess the extent of cancer spread (i.e., the stage).

If your doctor suspects abnormalities during an imaging test or if they feel like more information is needed, they may recommend a biopsy for further evaluation:

Endometrial sampling - During an endometrial biopsy, the doctor passes a thin tube through your cervix into the womb. Through the tube, they extract a small piece of tissue from the womb lining. Most people experience cramps when this procedure is done.

Hysteroscopy - Hysteroscopy is a thin tube with a fiber-optic camera. This method allows visualization of the inner womb and biopsy of suspicious areas. Taking a biopsy is technically a separate procedure and not part of a hysteroscopy, but rather, paired with a hysteroscopy. Most people will also experience cramping when this procedure is done. Sometimes this is actually done in the operating room so that anesthesia can be given to avoid experiencing the cramps.

Dilation and curettage (D&C) - D&C is a more complex procedure involving dilation of the cervix. It takes place under anesthesia in the operating theatre. This procedure may be done if:

• Other biopsy techniques fail to provide a diagnosis
• The patient has heavy bleeding
• The patient has Lynch syndrome

After biopsy, regardless of the method, the doctor will send the tissue sample to a laboratory for testing.

A diagnosis includes details such as the type and grade of cancer, which help inform the outlook and guide treatment decisions.

Classically, the two primary types of uterine cancer are Type 1 and Type 2. These two categories are distinguished by factors such as:

• The appearance of cancer cells under microscope
• The aggressiveness or growth of cancer cells
• Their responses to different hormones

There are further subtypes within these two categories, adenocarcinoma and endometrioid carcinoma. Adenocarcinoma and endometrioid carcinoma account for nearly 80% of cases. Adenocarcinoma is a more general term and will frequently be clarified during the course of treatment. Other rare forms include:

• Serous carcinoma
• Carcinosarcoma
• Clear cell carcinoma
• Small cell carcinoma
• Squamous cell carcinoma
• Mixed or transitional carcinoma

Molecular subtyping is emerging as an important tool in informing prognosis and even guiding specific treatments, such as immunotherapy, hormonal therapy and other treatment strategies. Profiling of molecular subtypes helps tailor a more personalized treatment for cancer patients.

Staging is also a key component of cancer diagnosis. It informs:

• Stage 1: Cancer has not spread out of the womb
• Stage 2: Cancer has spread to the cervix
• Stage 3: Cancer has extended to the vagina, ovaries and/or lymph nodes
• Stage 4: Cancer has spread to the bladder or distant organs

Usually, your doctor may not have sufficient information to determine the cancer stage until they perform surgery to remove it.

It is important to be aware of changes in your body and seek medical advice if you notice anything unusual. If necessary, your doctor will guide you through the appropriate diagnostic tests along with the next steps. Rest assured, your healthcare team will provide the support and guidance you need throughout the process.