An accurate endometrial cancer diagnosis starts with the right testing. Dr. Joshua Cohen explains the diagnostic process step-by-step, including key tests, as well as the role of imaging and staging. Dr. Cohen goes on to share self-advocacy advice to help patients access a correct diagnosis and to receive quality care.
Dr. Joshua G. Cohen is a board-certified gynecologic oncologist and Medical Director of the Gynecologic Cancer Program at the City of Hope Orange County. Learn more about Dr. Cohen.
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Transcript
Katherine:
Dr. Cohen, when someone is diagnosed with endometrial cancer, what essential tests should they receive?
Dr. Josh Cohen:
Yeah. For endometrial cancer, the most important thing is the correct diagnosis. And if you’ve been diagnosed with endometrial cancer based on a biopsy, it’s important to talk to your OB-GYN doctor or your cancer doctor, if you’ve met one. Is that biopsy sufficient? Do you need additional testing to determine what type of cancer this is?
If you’re being seen at a community-based hospital, it’s okay to, perhaps, get a second opinion with that pathology report at a larger comprehensive cancer center, especially if the tumor histology, meaning the type of cancer under the microscope is a more rare or aggressive cancer. Once, though, someone has made the determination that you have endometrial cancer or uterine cancer, the next step is then asking what appropriate imaging is needed? Do you need a CT scan? Do you need a pelvic ultrasound? Do you need an MRI? Is there a role for a PET/CT scan?
And then beyond that, we need to assign a stage to the cancer. A stage is an anatomical description of where the cancer is located. Did it travel to the lymph nodes? Did it travel to the upper abdomen? Did it travel to the chest? For endometrial or uterine cancer, this is a surgically staged cancer. And so, you would want to then talk to your doctor about a needed surgery where they would sample lymph nodes. And we have the ability now to do a sentinel lymph node dissection where we can identify the very first lymph nodes that are closest to the uterus and remove just those to minimize toxicity, meaning we can reduce the risk of lymphedema if we’re only removing those sentinel lymph nodes.
Whereas, in prior years, we would remove a number of lymph nodes from the pelvis up to the aorta where your belly button is.