There is no useful screening test and routine pelvic exams rarely find this disease. Most women are diagnosed because they have symptoms.

Signs and Symptoms of Endometrial Cancer

Unusual bleeding, spotting, or other discharge: If you have gone through menopause, it is especially important to report unusual vaginal bleeding, spotting, or discharge to your doctor.

About 90% of patients diagnosed with endometrial cancer have irregular vaginal bleeding or bleeding after menopause. Although this symptom also can occur with hyperplasia and some other non-cancerous conditions, it is important to have a doctor look into any irregular bleeding right away.

Non-bloody vaginal discharge may also be a sign of endometrial cancer. Even if you cannot see blood in the discharge, that does not mean there is no cancer. In about 10% of cases, the discharge associated with endometrial cancer is not bloody. Any abnormal discharge should be checked out by your doctor.

Pelvic pain and/or mass and weight loss: These symptoms usually occur in later stages of the disease. Nonetheless, delays in seeking medical help may allow the disease to progress even further. This lowers the odds for successful treatment.

History and Physical Exam

If a woman has any of the symptoms of endometrial cancer described above, she should visit her doctor. The doctor will ask her about her symptoms, risk factors, and family medical history. The doctor will also perform a general physical exam and a pelvic exam.

Consultation with a Specialist

If the doctor thinks a woman might have endometrial cancer, she should be examined by a gynecologist, a doctor qualified to diagnose and treat diseases of the female reproductive system. Specialists in treating cancers of the endometrium and other female reproductive organs are called gynecologic oncologists.

Sampling Endometrial Tissue

To find out whether endometrial hyperplasia or endometrial cancer is present, the doctor must remove some tissue so that it can be looked at under a microscope. Endometrial tissue can be obtained by endometrial biopsy or by dilation and curettage (D & C) with or without a hysteroscopy. A specialist such as a gynecologist usually does these procedures, which are described below.

Endometrial biopsy: An endometrial biopsy is a procedure in which a sample of endometrial tissue is obtained through a very thin flexible tube inserted into the uterus through the cervix. The tube removes a small amount of endometrium using suction. The suctioning takes about a minute or less. The discomfort is similar to menstrual cramps and can be helped by taking a nonsteroidal anti-inflammatory drug such as ibuprofen before the procedure.

This is the most commonly performed test for endometrial cancer. It can be done in the doctor’s office.

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

Hysteroscopy: This is a technique that allows doctors to look inside the uterus. If the endometrial biopsy didn’t find the problem, then doctors can insert a tiny telescope (about 1/6 inch in diameter) into the uterus through the cervix. The uterus is then expanded by filling it with salt water (saline). This lets the doctor see what might be causing any bleeding, such as a cancer or a polyp. The abnormality can then be biopsied. This is usually done with local anesthesia (numbing the local area), so that the patient can stay awake. This is the most accurate way of looking for cancer.

Dilation and curettage (D & C): If the endometrial biopsy sample doesn’t provide enough tissue, or if the biopsy suggests cancer but the results are uncertain, a D & C must be done. In this outpatient procedure, the opening of the cervix is enlarged (dilated) and a special instrument is used to scrape tissue from inside the uterus. This may be done with or without a hysteroscopy.

The procedure takes about an hour and may require general anesthesia (where you are asleep) or conscious sedation (medicine given into a vein to make you drowsy but still awake). A D & C is usually done in an outpatient surgery area of a clinic or hospital. Most women have little discomfort after this procedure.

Testing of Endometrial Tissue

Endometrial tissue samples removed by biopsy or D & C are looked at under the microscope to see whether cancer is present. If cancer is found, it will be described and graded. The lab report will state what type of endometrial cancer it is.

The grade of the endometrial cancer, which is based on how it looks under the microscope, is very important. If 95% or more of the cancer looks like glands of normal endometrial tissue, it is called grade 1. Grade 2 tumors have between 50% and 94% normal-looking gland formations. Cancers with less than half of the tissue forming glands are given a grade of 3. Women with lower grade cancers are less likely to have advanced disease or recurrences.

Imaging Tests for Endometrial Cancer

Transvaginal ultrasound or sonography: Transvaginal ultrasound uses sound waves to create images of the uterus. A probe inserted into the vagina gives off sound waves that echo off the pelvic organs. The pattern of echoes is analyzed by a computer to create images on a video screen. These images often help show whether a tumor is present and may be able to determine if it extends into the myometrium.

In order for the doctor to see the uterine lining more clearly, saltwater (saline) may be put through a small tube into the uterus before the sonogram. This procedure is called a saline infusion sonogram or ultrahysterosonogram. Sonography may help doctors direct their biopsy if other procedures didn’t spot a tumor.

Cystoscopy and proctoscopy: If a woman has symptoms or signs that suggest the endometrial cancer has spread to the bladder or rectum, the inside of these organs can be looked at through a lighted tube. In cystoscopy the tube is placed into the bladder through the urethra. In proctoscopy the tube is placed in the rectum. These exams allow the doctor to look for possible cancers. Small tissue samples can also be removed during these procedures for pathologic (microscopic) testing. They can be done using a local anesthetic but some patients may require general anesthesia. Your doctor will let you know what to expect before and after the procedure.

Computed tomography (CT): The CT scan is an x-ray procedure that creates detailed cross-sectional images of your body. Instead of taking one picture, as with a standard x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines these pictures into an image of a slice of your body. The machine will take pictures of many slices of the part of your body that is being studied.

CT scans are rarely used to diagnose endometrial cancer. They may be helpful if the cancer is thought to be advanced or if it looks like the cancer has come back after treatment. This test can help tell if the cancer has spread into the liver or other organs. After the first set of pictures is taken you may have an IV (intravenous) injection of a "dye" (radiocontrast agent) that helps better outline structures in your body. A second set of pictures is then taken.

CT scans can also be used to precisely guide a biopsy needle into a suspected area of cancer spread. For this procedure, called a CT-guided needle biopsy, you remain on the CT scanning table while a doctor moves a biopsy needle toward the mass. CT scans are repeated until the doctor is sure that the needle is inside the mass. A fine needle biopsy sample (tiny fragment of tissue) or a core needle biopsy sample (a thin cylinder of tissue about ½ inch long and less than 1/8 inch in diameter) is removed and looked at under a microscope.

CT scans take longer than regular x-rays. But just like other computerized devices, they are getting faster and your procedure might be pleasantly short. You might feel a bit confined by the ring you lie within when the pictures are being taken.

You may need to have an IV (intravenous) line through which the contrast "dye" is injected. The injection may cause some flushing. Some people are allergic and get hives or rarely more serious reactions like trouble breathing and low blood pressure. Be sure to tell the doctor if you have ever had a reaction to any contrast material used for x-rays. You may be asked to drink one to two pints of a solution of contrast material. This helps outline the intestine so that it is not mistaken for tumors.

Magnetic resonance imaging (MRI): MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases. A computer translates the pattern of radio waves given off by the tissues into a very detailed image of parts of the body. This creates cross sectional slices of the body like a CT scanner and it also produces slices that are parallel with the length of your body.

MRI scans are particularly helpful in looking at the brain and spinal cord. Some doctors also think MRI is a good way to tell whether, and how far, the endometrial cancer has grown into the body of the uterus. MRI scans may also help find enlarged lymph nodes with a new technique that uses very tiny particles of iron oxide. These are given into a vein and settle into lymph nodes where they can be spotted by MRI.

A contrast material might be injected with MRI just as with CT scans, but this is done less often. MRI scans are a little more uncomfortable than CT scans. First, they take longer -- often up to an hour. Also, you have to be placed inside a tube, which is confining and can upset people with fear of enclosed places. (Newer, “open MRI” machines can help people with this fear.) The machine also makes a thumping or buzzing noise that you may find disturbing. Some places will provide headphones with music to block this out.

Positron emission tomography (PET): PET scans use a form of sugar (glucose) that contains a radioactive atom. Cells of the body absorb different amounts of the sugar, depending on their rate of metabolism. The substance gives off tiny sub-atomic particles called positrons. A special camera records the location of the positrons as they leave the body.

Unlike most other imaging tests which provide views of the shape and size of internal structures only, PET scanning also provides information about their metabolic activity.

Since the metabolism of cancer cells differs from that of normal cells, PET is sometimes useful in identifying cancers and determining how far they may have spread. But PET scans are not routinely ordered, and their role in endometrial cancer is still being studied.

Chest x-ray: This test can show whether the cancer has spread to the lungs. It may also be used to see if there are any serious lung or heart diseases, especially before surgery.

Intravenous pyelogram (IVP): If it looks like the cancer may have spread around the ureters (the tubes that connect the kidneys to the bladder), an IVP may be done. This is an x-ray test that outlines the urinary system. However, a computed tomography (CT) scan with contrast will provide the same information and is used more often than an IVP.

Blood Tests

Complete blood count: This test is done to make sure you are able to have surgery safely. Many times women with a lot of blood loss from the uterus will be anemic (have low red blood cell counts).

CA 125 blood test: CA 125 is a substance released into the bloodstream by many, but not all, endometrial and ovarian cancers. Very high blood CA 125 levels suggest that an endometrial cancer has probably spread beyond the uterus. Some doctors will use this in deciding whether surgery should be done by a gynecologic oncologist. If CA 125 levels are high before surgery, some doctors use follow-up measurements to find out how well the treatment is working (levels will drop after surgery if treatment is effective) and to see if the cancer has come back after initially successful treatment.

Revised: 11/27/2006