How is uterine cancer diagnosed and staged?

Abnormal vaginal bleeding must always be thoroughly investigated in a manner that includes taking a sample of the lining of the uterus. A pap smear is an unreliable means of investigating possible cancer of the endometrium and is not used for this purpose. Physical examination of the lower genital tract (vulva, vagina and cervix) should be performed to exclude other local causes of bleeding. A pelvic ultrasound examination may also be performed at this stage.
Direct examination of the lining of the uterus by hysteroscopy has become the most common means of diagnosing cancer of the lining of the uterus. In essence a thin instrument attached to a television camera is introduced along the vagina and through the cervix into the uterine cavity allowing thorough examination of the uterine cavity and allowing any abnormal areas to be sampled.
This may be performed as an outpatient with or without sedation or may be performed under light general anaesthesia in an operating theatre in a hospital or a day surgery unit. Sampling of abnormal areas my be undertaken by direct biopsy or scraping the suspicious areas or by curettage of the entire endometrial lining during the procedure.
Hysteroscopy also allows evaluation of the extent of a cancer in the endometrial cavity in so far as it can give an indication of how much of the lining is involved and whether there is direct extension to the cervix.The tissue collected at this procedure will be examined by an expert pathologist and may even be sent to a sub specialist pathologist with a particular interest in gynaecological oncology. Once cancer of the uterus has been diagnosed or confirmed you should be referred to a Certified Gynaecological Oncologist for further management and treatment.While awaiting this appointment you may have some blood tests as well as radiological examinations performed, these may include chest X-ray and may also include CT scanning of your abdomen and pelvis. Other tests that may be peformed include an MRI or a PET scan.
If cancer is confirmed further surgery is undertaken and this will be outlined below. Briefly the role of surgery in early cancer is to see if the cancer has spread to any other tissues including the lymph nodes. In more advanced cancer the role of surgery is to remove all or as much cancer as possible.Once the surgery is performed, patients are assigned a clinical stage known as the FIGO stage. This allows us to give our patients some idea as to the likelihood of success of treatment and to compare our treatments with other cancer groups around the world. An abbreviated FIGO staging system is shown.
Generally speaking the higher the stage, the more that the cancer has spread and the more serious the cancer.
Stage I: the cancer is confined to the uterus
Stage II: the cancer involves the uterine body and cervix
Stage III: the tumour has spread to the outside of the uterus, to the vagina or the lymph glands.
Stage IV: the cancer has either spread to the lining of the bladder or bowel or spread to distant organs.