Symptoms and diagnosis of endometrial cancer

The symptoms of endometrial cancer are:

• Abnormal vaginal bleeding (metrorrhagia) in women after the menopause or outside the menstrual period in non-menopausal women;
• Pelvic pain.

From the onset of these symptoms, diagnosis should be made during a clinical examination of the abdomen, pelvis and vagina by the gynecologist, using an endometrial sampling (endometrial biopsy). When clinically indicated, endometrial biopsy can be performed without anesthesia, at the time of consultation. The cervix then becomes permeable.

When the cervix is not permeable or if following the sampling there was no tissue to be analyzed, then a hysteroscopy must be performed. A hysteroscopy is a procedure that allows the inside of the uterus to be viewed through a small lens.

Here at Institut Curie, we prefer to perform a biopsy during a gynecology consultation, but when the clinical examination does not allow it, an “operative” hysteroscopy can be performed under anesthesia in the operating room to establish the diagnosis.

Once the diagnosis of cancer has been established, further investigations are prescribed to explore its extent locally (lumbopelvic MRI, i.e. to explore the pelvis and lumbo-aortic lymph nodes) and sometimes throughout the body (thoraco-abdomino-pelvic CT or PET scan).

A dedicated path for gynecological sarcoma

Gynecological sarcoma is an uncommon type of the uterine tumor. Its prognosis can be impaired by poor diagnostic or therapeutic management, which is why it is essential to be taken care of in an expert center such as Institut Curie in order to improve the prognosis of patients who have it. Institut Curie offers a dedicated patchway in case of suspected gynecological sarcoma (SARGYN). This pathway is carried out with the participation of expert radiologists, to assess the need for a specific protected biopsy, backed up by molecular biology analysis to better characterize the sarcoma. This specific pathway is reserved for young women wishing to preserve their fertility.

For postmenopausal women or women who do not wish to preserve their fertility, if the diagnosis of uterine sarcoma is suspected following a rigorous clinical and radiological analysis, a hysterectomy without fragmentation is recommended. In the case of large lesions, laparotomy (opening of the peritoneal cavity) is preferred to laparoscopy.