Endometrial (Uterine) Cancer Staging and Investigations

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endometrial-cancer

If someone is suspected to have endometrial cancer based on signs and symptoms, certain investigations are required to confirm the diagnosis of the disease. Further, these can help in determining the stage of the disease, which in turn help in choosing an appropriate treatment option.

Endometrial (Uterine) Cancer FIGO Staging

Endometrial Cancer FIGO Staging is the most commonly used staging system for the disease. FIGO stands for International Federation of Gynecology and Obstetrics.

FIGO Stage IA

The primary tumor is limited to the endometrium or has invaded less than half of myometrium.

FIGO Stage IB

The primary tumor has invaded half or more of the myometrium.

stage 1, invades myometrium

FIGO Stage II

The primary tumor is present only in the uterus and has extended up to the cervical connective tissue.

stage 2 invades cervix

FIGO Stage IIIA

The cancer cells have spread to the outer surface of the uterus (serosa) or to the fallopian tube, ovary, round/broad ligament (adnexa).

stage 3A invades ovary

FIGO Stage IIIB

The cancer cells have spread to the vagina or up to the parametrium.

stage 3b, invades vagina or parametrium

FIGO Stage IIIC1

Cancer has spread to pelvic lymph nodes but not to the lymph nodes along the aorta or to distant body parts.

stage 3c1, invades pelvic lymph nodes

FIGO Stage IIIC2

Cancer has spread to the lymph nodes along the aorta but not to the distant body parts.

stage 3c2, invades para-aortic lymph nodes

FIGO Stage IVA

Cancer has spread up to the mucosa of the rectum or urinary bladder.

stage 4a, invades bladder or bowel mucosa

FIGO Stage IVB

The cancer cells have spread to distant body parts such as distant lymph nodes, lungs, bones, liver, etc.

stage 4b, metastasis to distant sites

 

Endometrial Cancer FIGO Staging - stage I to stage IIIIb

endometrial cancer figo staging - stage IIIc and stage IV

Where does Endometrial Cancer usually metastasize?

Endometrial cancer is uaually diagnosed early as it manifests as per vaginal bleeding early in disease course. So, advanced stages of disease are less common. But despite that, it may spread to distant sites of the body. Most common sites of spread of uterine cancer are bone, liver, lung, peritoneum and vagina.

The extent of locoregional infiltration of the tumor into the endometrial wall may be a risk factor for lymph nodal and distant metastasis.

What is the Life Expectancy/Survival Rate of Endometrial Cancer? 

Survival rates give you an idea of percentage of people that are alive 5 years after being diagnosed with endometrial cancer. It does not tell how long they live, but helps in better understanding of the treatment response. Also, what needs to be understood is that these survival rates are an average of the patients with same type and stage of cancer, that are compared to general population without the disease.

It is calculated based on whether the disease is Localised, Regional or Distant.

Localised

  • Cancer is limited to the endometrium.
  • 5 year survival 95%

Regional

  • Cancer has spread to nearby structures or lymph nodes.
  • 5 year survival 69%

Distant

  • Cancer has spread to distant body parts.
  • 5 year survival 17%

What are the Symptoms of Advanced Stage Endometrial Cancer?

Symptoms of advanced disease may be caused due to local involvement of nearby structures and metastasis to distant sites.

Local spread may cause:

  • Pressure like sensation in lower abdomen
  • Uterine bleeding that is irrgeular and/or out of proportion to normal
  • Painful sexual intercourse
  • Vaginal discharge that appears unusual

Distant spread may cause:

  • Bone pain, back pain
  • Yellowish discoloration of eyes and/or urine
  • Chest discomfort, cough, breathlessness
  • Abdominal distension and/or discomfort, bloating

What are the Investigations for Diagnosis and Staging of Uterine (Endometrial) Cancer?

If someone is suspected to have endometrial cancer based on signs and symptoms, certain investigations are required to confirm the diagnosis of the disease. Further, these can help in determining the stage of disease, which in turn help in choosing an appropriate treatment option.

Transvaginal Ultrasound (TVUS)

Transvaginal Ultrasound (TVUS)

In this technique, a special vaginal probe is used, which directs very high-frequency sound waves towards the internal body parts to be examined. The sound waves are reflected off the internal structures depending upon their ability to reflect these waves and collected by a special detector to produce a real-time image of the internal tissues on a computer screen.

This helps the doctor to examine the endometrium, fallopian tubes, ovaries, and other nearby structures for any abnormality. This test can detect any solid tumors (appear as a solid mass) or abnormal endometrial thickening that may indicate endometrial cancer. This test can also provide information regarding the location, extent of disease or invasion into the muscle layer (myometrium).

Hysteroscopy

Hysteroscopy

In this technique, a tiny telescope-like device is inserted into the uterus through the vagina and cervix to closely examine the endometrium. This enables a doctor to determine any abnormal area(s) and to collect biopsy samples from such area(s) observed during the test.

Endometrial Biopsy

Endometrial Biopsy

Biopsy sample(s) from the endometrium is generally collected in case an abnormal area(s) is observed during the TVUS or hysteroscopy procedure. This can be removing a small amount of endometrial tissue via a thin tube inserted into the uterus through the cervix.

In case the collected biopsy sample is inadequate or patient is being considered for a fertility-sparing treatment, a dilation and curettage (D&C) can be performed. In D&C, the cervix is dilated and endometrial tissue is scraped from inside of the uterus using special instruments.

The collected biopsy sample is then tested in a laboratory for the presence of any abnormal/cancerous cells.

It is recommended to collect and analyze biopsy samples to confirm the diagnosis of endometrial cancer. The biopsy sample can provide very useful information about the cancer cells such as the type of cancer, the severity of cancerous changes involved (grade of cancer), and the presence of specific defective genes or proteins.

Imaging Tests

These tests are generally employed after the establishment of the pathological diagnosis. They help to detect the spread of disease to distant body parts and assess the stage of the disease so that an appropriate treatment option can be selected. Alternatively, these tests are employed after treatment to evaluate the treatment efficacy and to detect disease response, progression, or recurrence.

Computed tomography (CT) scan

CT Scan

In this technique, detailed cross-sectional images of body organs are generated using x-rays, with or without a contrast medium. It can help diagnose the spread of disease to nearby/distant lymph nodes and other organs, and may also be used to guide a biopsy needle into the affected area.

Positron emission tomography (PET) scan

PET Scan

This technique uses a radioactive substance (e.g.fluorodeoxyglucose [FDG]) that is given intravenously prior to the procedure. Cancer cells absorb larger amounts of the radioactive substance than normal cells.

The areas of higher radioactivity indicate cancerous tissue on the PET scan. Thus, this technique can diagnose the spread of disease to distant body parts. It is usually combined with a CT scan (PET/CT).

Magnetic resonance imaging (MRI) scan

MRI Scan

This technique provides detailed images of tissues inside the body using radio waves, a strong magnetic field, and gadolinium contrast. It can accurately diagnose the extent of invasion and spread of disease to nearby/distant body parts.

Chest X-ray

This is a relatively less-sensitive imaging technique that can reveal the spread of cancer to lungs or pleura. Spread to lungs or pleura may appear as nodule(s), pleural effusion, etc.

Blood tests for tumor markers

Tumor markers are generally proteins or other substances that are produced by both normal cells and cancer cells. However, in the case of cancer, the level of these markers rises in the blood, urine, or other biological fluids, which can be detected by certain laboratory tests. Level of cancer antigen (CA)-125 has been reported to be elevated in many patients with endometrial cancer.

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