When diagnosing endometrial cancer (EC), your healthcare team will give your case a grade based on how the cancer cells look. This grading system describes how quickly the cancer will grow, and helps guide your treatment.
How doctors determine EC grade
When first diagnosing EC, your doctor will take an endometrial biopsy, a small sample of tissue collected from the uterus. (If a biopsy is unsuccessful in collecting tissue samples, a dilation and curettage procedure is often used to scrape cells from the uterine lining for analysis.)
A pathologist (a doctor specializing in tissues) will examine the sample under a microscope. They will compare the sample’s cancer cells to normal cells to measure the differences in terms of size, shape, how the cells are arranged and how fast they are dividing. The number of cells dividing is an indicator of how fast the tumor is growing.
Based on their findings, the pathologist will give the cancer one of three grades; a lower number means a lower-grade, slower-growing cancer.
Understanding the grades of EC
The grading of endometrial tumors helps doctors better understand the cancer’s predicted growth, your treatment options, how you will respond to treatment and your potential outcomes or prognosis. The International Federation of Gynecology and Obstetrics (FIGO) uses three grades of EC:
Grade 1: Low-grade cancer with slower growth and less chance of spreading to other parts of the body. Cells look closer to normal. Preferred treatment is usually hysterectomy.
Grade 2: Also a low-grade cancer. Cells look moderately normal. Preferred treatment is usually hysterectomy followed by radiation.
Grade 3: High-grade cancer is more aggressive with faster growth and a higher risk of spreading. Cells are abnormal. Preferred treatment is usually hysterectomy followed by chemotherapy or radiation. There is a higher risk of recurrence.
What are cancer stages?
As well as grades of EC cancer, there are also associated stages. Stages and grades are often confused for one another, but they mean different things: while grade describes the aggresiveness of the cancer cells, stage describes how far the cancer has spread in the body.
Cancer is graded at the time of diagnosis. Staging, on the other hand, is generally determined during surgery, when how far it has spread is clearer, though imaging before surgery may give your doctors an earlier indication of the stage.
While cancer grading is determined with a biopsy, the information taken into consideration to ascertain stages includes:
- The EC grade.
- Which part of the uterus is affected.
- If the cancer has moved to the lymph nodes or surrounding tissue.
- If the cancer has moved to other organs (metastases).
- The molecular subtype.
- The cellular type of the cancer.
Your healthcare team will take you through the different stages and how they are used alongside grades to guide treatment and outcomes.
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