How is endometrial cancer found?

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.

Tests to find cancer early

Early detection refers to the use of tests to find a disease such as cancer in people who do not have symptoms of that disease.

Women at average endometrial cancer risk

At this time, there are no screening tests or exams to find endometrial cancer early in women who are at average endometrial cancer risk and who have no symptoms. Women should talk to their doctors about getting regular pelvic exams, including Pap tests. Although the Pap test can find some female cancers early, most cases of endometrial cancer are not found by this test. But the Pap test is very good at finding early cancer of the cervix (the lower part of the uterus).

After menopause you should tell your doctor if you have any discharge or bleeding that is not normal. This could be a sign of endometrial cancer.

Women who have a higher risk of endometrial cancer

Women at high risk for this cancer should also see their doctor whenever they have any vaginal bleeding that is not normal. This includes women who:

• Are older
• Had late menopause
• Never gave birth
• Are unable to get pregnant (infertile)
• Are obese
• Have diabetes
• Have high blood pressure
• Are using estrogen treatment
• Are taking tamoxifen

If several family members have had colon or endometrial cancer, you might want to think about having genetic counseling to learn about your family’s risk of having hereditary nonpolyposis colon cancer (HNPCC). If you (or a close relative) have genetic testing and are found to have a change in one of the genes for HNPCC, you have a high risk of getting endometrial cancer. To find out more about genetic testing, please see our document, Genetic Testing: What You Need to Know.

The American Cancer Society recommends that women who have (or may have) HNPCC be offered yearly testing with an endometrial biopsy beginning at age 35. Their doctors should discuss this test with them, including its risks, benefits, and limits. This applies to women known to carry HNPCC-linked gene changes (mutations), women who are likely to carry such a change (those with a mutation known to be present in the family), and women from families which tend to get colon cancer where genetic testing has not been done.

Another option for a woman who has (or may have) HNPCC would be to have a hysterectomy once she is finished having children.

Signs and symptoms of endometrial cancer

Unusual bleeding, spotting, or other discharge

About 9 out of 10 women with endometrial cancer have some type of abnormal vaginal bleeding. For a woman who has gone through the change of life (menopause), this can mean bleeding or spotting after she has stopped having periods. Before menopause, this means a change in your periods or bleeding or spotting between periods.

Less often, women with endometrial cancer have a discharge that does not look like it contains blood. Abnormal discharge is more often caused by something other than cancer, but it still needs to be checked out.

If you have abnormal vaginal bleeding or discharge, you should see a doctor.

Pelvic pain or a mass and weight loss

Pain in the pelvis, feeling a lump (mass), and losing weight without trying can also be symptoms of endometrial cancer. These symptoms usually happen in the later stages of the disease. Still, you should see the doctor right away because a delay in getting treatment can allow the cancer to get worse. This lowers the chance that treatment will work.

What will happen next?

History and physical exam: 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.

Seeing a specialist: 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.

Getting a sample of endometrial tissue

To find out whether the problem is endometrial hyperplasia or 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 (this stands for dilation and curettage). These are described below.

Endometrial biopsy: 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. The discomfort is much thing 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. Ultrasound (see below) is often done before the biopsy. This helps the doctor find any suspicious areas that should be sampled.

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. To do this, the cervix is opened (dilated) and a special instrument is used to scrape tissue from inside the uterus. It takes about an hour and you may have medicine to make you sleep (general anesthesia) or drowsy. Other options are local anesthesia put into the cervix, a spinal, or an epidural. D & C is most often done in the outpatient surgery of a clinic or hospital. 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 lab report will give these details.

The lab will also give a grade to the cancer. If most of the cancer cells look like normal tissue, it's given a grade 1. If most of the cells look very different from normal cells, it's given a grade of 3. Grade 2 tumors fall somewhere in between. The grade is important because women with lower grade cancers are less likely to have cancer that has spread or have the cancer come back after treatment.

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. If these changes are present, the doctor may recommend that you see a genetic counselor to talk about genetic testing for the genes that cause HNPCC. 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 for endometrial cancer

Ultrasound: Ultrasound is the use of sound waves to take pictures of the inside of the body. When this test is done for possible endometrial cancer, a probe is placed into the vagina. It gives off sound waves that echo off the tissue of the pelvic organs to make a picture on a video screen. These pictures often help 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. Salt water (saline) might be put into the uterus before the test to give a clearer picture.

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 it looks as if the cancer has come back or has 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 that you may find disturbing. Many places will give you headphones with music to block this out. A contrast dye might be used, just as with 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. But PET is not a routine part of the work-up of endometrial cancer, and its role is still being studied.

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.

Blood tests

Complete blood count (CBC): This test measures the different cells in the blood, like the red blood cells, white cells, and platelets. 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. In someone with endometrial cancer, very high blood CA 125 levels are a sign that the cancer has likely spread beyond the uterus. If CA 125 levels are high before surgery, some doctors will 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.