How We Diagnose and Stage Endometrial/Uterine Cancer

If a woman has symptoms that suggest uterine cancer, City of Hope doctors may perform one or more of the following exams or tests:


  • Pelvic exam: The doctor will check for abnormalities such as lumps in the uterus.
  • Pap smear: The doctor collects cells from the cervix, which are examined by a medical laboratory for abnormalities. Although a Pap test can detect cancer of the cervix, cells from inside the uterus usually do not show up on a Pap test. This is why a doctor collects samples of cells from inside the uterus in a procedure called a biopsy.
  • Transvaginal ultrasound: The doctor inserts an instrument into the vagina that aims high-frequency sound waves at the uterus. The pattern of the echoes they produce creates a picture. If the endometrium looks too thick, the doctor may recommend a biopsy.
  • Biopsy: The doctor removes a sample of tissue from the uterine lining. This usually can be done in the doctor's office. In some cases, however, a woman may need to have a dilation and curettage, often referred to as a D&C. A D&C is typically a same-day surgery with anesthesia. A pathologist examines the tissue to check for cancer cells, hyperplasia and other conditions.

If uterine cancer is diagnosed, City of Hope doctors needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has spread, and if so, to what parts of the body.


Our doctors may order blood and urine tests and chest X-rays. The woman also may have other X-rays, computed tomography scans, an ultrasound test, magnetic resonance imaging, sigmoidoscopy or colonoscopy.


In most cases, the most reliable way to stage uterine cancer is to remove the uterus (hysterectomy). After the uterus has been removed, the City of Hope surgeon can look for obvious signs that the cancer has invaded the muscle of the uterus. Our surgeon also can check the lymph nodes and other organs in the pelvic area for signs of cancer. A pathologist uses a microscope to examine the uterus and other tissues removed by the surgeon.


These are the main features of each stage of the disease:


  1. Stage I – The cancer is only in the body of the uterus. It is not in the cervix.
  2. Stage II – The cancer has spread from the body of the uterus to the cervix.
  3. Stage III – The cancer has spread outside the uterus, but not outside the pelvis (and not to the bladder or rectum). Lymph nodes in the pelvis may contain cancer cells.
  4. Stage IV – The cancer has spread into the bladder or rectum. Or it has spread beyond the pelvis to other body parts.