Advances in Diagnosis and Staging for Endometrial Cancer
It’s important to identify women at risk. Then, they can get the best possible treatment starting when cancer is first suspected. A recent study focused on determining risk of endometrial cancer. It involved women who had a uterine biopsy that showed precancerous cells in the lining of the uterus.
When a woman has abnormal bleeding, her doctor often suggests a biopsy. For the biopsy, the doctor takes a small piece of tissue from the lining (endometrium) of the uterus. The biopsy is usually done in the office. Then, a specialized doctor, called a pathologist, looks at the cells under a microscope. The pathologist is checking for cancer or other problems. Certain abnormal cells that show up in the biopsy are called atypical endometrial hyperplasia. These cells are believed to be precancerous. They are the step right before invasive endometrial cancer. Doctors typically advise women who have these cells to have a hysterectomy. Doing so lowers their chance of getting uterine cancer. That’s because it removes all of the uterus and its abnormal lining.
In this study, 40% of women who had hysterectomies actually had endometrial cancer. Luckily, most of the cancers were early and had not spread. Forty percent is a high rate of cancer. So women who have atypical endometrial hyperplasia might want to ask that a gynecologic oncologist to be part of their care.
Advances in Staging
Knowing the stage of endometrial cancer is important. It helps doctors determine the best treatment based on whether the cancer is early or advanced. Having the best possible treatment from the beginning is the best chance of cure.
Staging involves knowing whether cancer cells have spread outside the uterus. In a recent study, researchers stressed that the best information about spread comes from surgeons checking lymph nodes near the uterus. Even small amounts of cancer cells with the lymph gland indicate the cancer is Stage III. Other studies, though, have challenged the value of lymph node surgery. One study by the Medical Research Council in the UK questioned whether all women with early cancer benefit from lymph node removal. The results showed lymph node surgery had low value. There was, though, a tendency to use radiation therapy more often when lymph nodes were not removed. Despite the debate, women should ask about the rationale for lymph node surgery. They should discuss it with a surgeon who is knowledgeable of endometrial cancer and skilled in endometrial cancer surgery. The Gynecologic Cancer Foundation has a workbook. It’s called Understanding Your Diagnosis of Endometrial Cancer. It provides information about treatment and suggests questions patients should review with their doctor. The workbook is available from our Educational Materials section.