Most women are diagnosed with endometrial cancer because they have symptoms. Watching for any signs and symptoms of this cancer 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.

Early detection tests

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

Women at average endometrial cancer risk

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 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

Women who have (or are at risk for) a certain type of colon cancer (called hereditary nonpolyposis colon cancer, or HNPCC), should have yearly testing with an endometrial biopsy beginning at age 35. Another option would be for the woman to have a hysterectomy once she is finished having children.

Signs and symptoms of endometrial cancer

Unusual bleeding, spotting, or other discharge

If you have gone through change of life (menopause) it is very important to tell your doctor about any bleeding or spotting that is not normal. About 9 out of 10 women with endometrial cancer have some type of abnormal vaginal bleeding, but some have discharge that does not look like blood. Abnormal discharge also can be caused by something other than cancer. But if you have gone through menopause, it is really important to report any vaginal bleeding, spotting, or discharge to your 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.

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. Ultrasound (see below) is often done before the biopsy. This helps the doctor find any suspicious areas that should be biopsied.

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 need medicine to make you sleep (general anesthesia). D & C is most often done in an outpatient surgery area 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.

Imaging tests for endometrial cancer

Ultrasound: Ultrasound is the use of sound waves to take pictures of the inside of the body. For this test, 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. This test can be used to see if there is a tumor. It could also show whether the tumor is growing into the outer 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.

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. Sometimes newer "open MRI" machines are used. The machine makes 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 often used for endometrial cancer.

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.

IVP (intravenous pyelogram): An IVP may be done if the doctor thinks the cancer might have spread to the urinary tract or nearby tissues. An IVP is an x-ray that outlines the urinary system. But CT scans are used more often than IVP.

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. 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.

Last Medical Review: 11/18/2009
Last Revised: 11/18/2009