How is endometrial cancer diagnosed?
Most women are diagnosed with endometrial cancer because they have symptoms. Watching for any signs and symptoms of this cancer (like abnormal vaginal bleeding or discharge) and telling your doctor about them right away allows the cancer to be found at an early stage. Finding it early improves the chances that it will be treated with success. But sometimes this cancer can reach an advanced stage before it causes any symptoms.
Seeing your doctor
If you have symptoms of endometrial cancer you should see your doctor. The doctor will ask about your symptoms, risk factors, and the health of your family members. The doctor will also do a physical and a pelvic exam.
If the doctor thinks you might have endometrial cancer, you should see a gynecologist -- a doctor with special training in finding and treating diseases of the female reproductive system. These doctors can help diagnose endometrial cancer and treat some early cases. You may also need to see a gynecologic oncologist -- a doctor with special training in treating cancers of the endometrium and other female reproductive organs. These doctors treat both early and advanced cases of endometrial cancer.
If the doctor suspects endometrial cancer or another problem with the uterus, he or she will order an ultrasound of the uterus.
Ultrasound is the use of sound waves to take pictures of the inside of the body. For this test, gel is usually applied and a special wand that gives off sound waves is placed on the skin to look at the organs of the abdomen (belly) and pelvis. To get a better look at the uterus, the wand is often placed into the vagina. Salt water (saline) might be put into the uterus before the test to give a clearer picture.
An ultrasound can show whether the endometrium has become thicker than it should be. It may also help see if a cancer is growing into the muscle layer of the uterus.
Getting a sample of endometrial tissue
In order to know if the problem is really endometrial cancer, the doctor must remove some tissue so that it can be looked at under the microscope. Tissue can be taken out by doing an endometrial biopsy or by a D & C (dilation and curettage). These are described below.
This kind of biopsy can be done in a doctor's office. A very thin flexible tube is placed into the uterus through the cervix. Then suction is used to remove a small amount of endometrium. The suction usually takes less than a minute. This often causes discomfort much like menstrual cramps and can be helped by taking a drug like ibuprofen before the test. Sometimes numbing medicine is put into the cervix just before the test to help reduce the pain.
Hysteroscopy: This is a way that doctors can look inside the uterus. The doctor puts a tiny telescope into the uterus through the cervix. The uterus is then filled with salt water (saline). This lets the doctor see and take a sample of anything that might be causing a problem, such as a cancer or a polyp. You stay awake for this, and the biopsy is done after the area is numbed with medicine.
Dilation and curettage (D & C): If the biopsy sample doesn't get enough tissue, or if the doctor can't tell for sure whether it is cancer, a D & C must be done. This involves opening (dilating) the cervix and using a special instrument to scrape tissue from inside the uterus. This is done in the operating room under general anesthesia (you are asleep) or a spinal or epidural (medicine injected into the area around the spinal cord to make you numb from the waist down. Most women have little pain afterwards.
Testing the tissue
Tissue that has been taken out is looked at under a microscope to see whether there are cancer cells in it. If cancer is found, the cells will be studied to learn more about the cancer (the type and grade). The lab report will give these details.
If the doctor suspects that hereditary nonpolyposis colon cancer (HNPCC) is linked to your endometrial cancer, the tumor tissue can be tested for certain changes that can happen when one of the genes that causes HNPCC is faulty. Testing of tumor tissue is most often ordered in patients who are found to have endometrial cancer at an earlier than usual age or who have a family history of endometrial or colon cancer.
Imaging tests to look for cancer spread
Cystoscopy and proctoscopy: If a woman has signs that suggest the cancer may have spread, the doctor can use a lighted tube to look at the inside of the bladder (cystoscopy) or rectum (proctoscopy). Small pieces of tissue can be removed to be looked at under a microscope. These tests are rarely needed.
CT scan: This is a special type of x-ray (also called a CAT scan) that makes detailed pictures of the inside of the body. CT scans are rarely used to find endometrial cancer, but they may be helpful if there are signs the cancer has come back or spread to other organs. CT scans can also be used to guide a biopsy needle into an area that could be cancer.
CT scans take longer than regular x-rays. You will need to lie still on a table while the scans are done. You may also have an IV (intravenous) line through which you get a contrast "dye." Some people are allergic to the dye and get hives or, rarely, problems like trouble breathing and low blood pressure. Be sure to tell the doctor if you have ever had a problem from any dye used for x-rays. You may also be asked to drink 1 to 2 pints of a liquid that helps outline the intestine so that it is not mistaken for tumors.
MRI scan (magnetic resonance imaging): MRI scans use radio waves and strong magnets instead of x-rays to take pictures. MRI scans are helpful in looking at the brain and spinal cord. They take longer than CT scans, and you may have to be placed inside a tube-like machine. This can be upsetting for some people. Special, “open” MRI machines can help with this if needed, but the drawback is that the images may not be as good. MRI machines make thumping or buzzing noises, so many places will give you headphones with music to help block it out. A contrast dye might be given into the vein, but it isn’t the same as the one used for CT scans.
PET scan (positron emission tomography): In this test, a type of radioactive sugar is used to look for cancer cells. The cancer cells take in large amounts of the sugar, which is put into your blood through an IV (intravenous) line. A special camera can then show where it goes in the body. PET is sometimes useful in finding small collections of cancer cells. PET is not often used when diagnosing endometrial cancer, but it may be done if the cancer has spread.
Chest x-ray: This can show if the cancer has spread to the lungs. It may also be used to look for serious lung or heart problems.
Complete blood count (CBC): This test measures the amount of red blood cells, white cells, and platelets in the blood. Many times women who have lost a lot of blood from the uterus will have low red blood cell counts. This is called anemia.
CA 125 blood test: CA 125 is a substance that many endometrial and ovarian cancers release into the bloodstream. This test doesn’t help find endometrial cancer, but it can be helpful in someone known to have this disease. Very high blood CA 125 levels can be a sign that the cancer has likely spread beyond the uterus. If CA 125 levels are high before surgery, doctors can track this number to find out how well the treatment is working. The levels will go down after surgery if all of the cancer cells have been removed. CA 125 levels may also be watched to see if the cancer has come back after treatment is done.
Last Medical Review: 11/08/2013
Last Revised: 02/03/2014