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Diagnosis and Prognosis of Uterine (Endometrial) Cancer

  • Cynthia M. Johnson, MA
Publication Type:

Condition InDepth

Diagnosis and Prognosis of Uterine (Endometrial) Cancer

The doctor will ask about your symptoms and health history. You will also be asked about your family health history. Physical and pelvic exams will be done. This may be enough to suspect uterine cancer. It can be confirmed with:

  • Endometrial biopsy—a sample of the endometrium is removed to look for signs of cancer
  • Transvaginal ultrasound—an ultrasound wand is inserted in the vagina to view the endometrium

Staging of Uterine Cancer

Tests will help to identify the stage of cancer. Staging looks at the cancer and whether it has spread. It will look at whether lymph nodes are involved. This will help guide treatment.

Surgical Staging

Robotic or laparoscopic surgery will be done through a cut in the abdomen. The pelvis will be examined for signs of cancer. Cancerous tumors, tissue, or organs may be taken out.


Tests that may be done are:

  • Images to look for tumors and how much the cancer has spread using:
  • Peritoneal wash—The pelvis and belly cavity are washed with a saline solution. Cells from the wash are tested for signs of cancer.
  • Cystoscopy—A scope is passed through the tube that carries urine out of the body. It can show if cancer has grown into this tube.
  • Sigmoidoscopy—A scope is passed into the lower colon and rectum. It will look for the spread of cancer.

Stages of Uterine Cancer

Uterine cancer is staged from I-IV (1-4):

  • Stage IA (1A)—Cancer is in the endometrium AND halfway or less through the muscle layer.
  • Stage IB (1B)—Cancer is in the endometrium AND halfway or more through the myometrium.
  • Stage II (2)—Cancer is in the uterus (endometrium and myometrium) AND is in cervical tissue.
  • Stage IIIA (3A)—Cancer is outside the uterus to the outermost layer AND/OR to nearby structures (fallopian tubes, ovaries, or supporting ligaments).
  • Stage IIIB (3B)—Cancer is in the vagina OR other tissue around the uterus.
  • Stage IIIC (3C)—Cancer is in the pelvic lymph nodes outside the uterus AND/OR near the aorta (the body's largest artery).
  • Stage IVA (4A)—Cancer is outside the pelvis AND in the bladder AND/OR colon or rectal walls.
  • Stage IVB (4B)—Cancer has spread outside the pelvis, and into the abdomen or the lymph and blood streams. Common sites for cancer that has spread are lymph nodes in other parts of the body, the lungs, liver, brain, and bones.

Grading of Uterine Cancer

Uterine cancer can be graded by how cells look under a microscope. It is grouped as low or high risk.

  • Low risk (grades 1 to 2)—Least likely to become invasive and spread
  • High risk (grade 3)—Most likely to become invasive and spread outside of the womb


  • Endometrial cancer. The American College of Obstetricians and Gynecologists website. Available at: https://www.acog.org/Patients/FAQs/Endometrial-Cancer.
  • Endometrial cancer. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/endometrial-cancer.
  • Endometrial cancer. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/gynecology-and-obstetrics/gynecologic-tumors/endometrial-cancer.
  • Fernandez C, Levine E, et al. Predictive value of three-dimensional transvaginal sonography for staging of endometrial neoplasia. Journal of Diagnostic Medical Sonography. 2018;34(6):496-500.
  • Renaud MC, Le T, et al. Epidemiology and investigations for suspected endometrial cancer. J Obstet Gynaecol Can 2018 Sep;40(9):e703.


  • Elizabeth Margaret Prusak, MD
Last Updated:

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.