How Is Endometrial Cancer Diagnosed?

 

If you have some of the symptoms of endometrial cancer, your doctor will begin your diagnosis by taking a medical history and giving you a physical examination.

  • Medical history and physical examination - Your doctor will take a complete medical history by asking you about your risk factors, symptoms, and other health problems or concerns. The doctor will also do a physical examination to look for signs of endometrial cancer and other health problems. This will include a pelvic examination to check your vagina, uterus, bladder, and rectum.

To find out whether you have endometrial cancer or another condition, your doctor will do a biopsy. This involves cutting out a small piece of tissue and sending it to a laboratory. A pathologist (doctor who specializes in diagnosing diseases) will look at the tissue under a microscope to see whether it has cancerous cells. A biopsy is the only way to be certain that you have endometrial cancer. The biopsy might be done by endometrial biopsy, hysteroscopy, or dilation and curettage.

  • Endometrial biopsy - The doctor inserts a thin flexible tube through your vagina into your uterus. The doctor then removes some cells from the lining of your uterus through this tube using suction. The doctor looks at the cells under a microscope to check for cancer. This is the most common test for endometrial cancer, and it can be done in your doctor’s office.
  • Hysteroscopy - The doctor inserts a tiny telescope (about one-sixth inch in diameter) into the uterus through the cervix. The doctor expands the uterus by filling it with salt water (saline). The doctor uses the telescope to see whether you have any abnormal areas in your uterus and removes these areas using dilation and curettage (see below) for examination under a microscope. This is the most accurate test for endometrial cancer. The doctor might use this technique if the endometrial biopsy did not reveal the cause of your problem.
  • Dilation and curettage (D & C) - The doctor enlarges (dilates) the opening of your cervix and uses a special instrument to scrape tissue from inside your uterus so that it can be examined under a microscope. This procedure can be done with or without a hysteroscopy and is used if the endometrial biopsy does not provide enough tissue or the results of the biopsy are not clear. D & C is usually done as same-day surgery in the hospital.

Imaging procedures allow your doctor to learn where the cancer is located and whether it has spread from the uterus to other areas of the body.

  • Chest x-ray - Your doctor might order a chest x-ray to find out whether endometrial cancer has spread to the lungs. Chest x-ray can also be used to find out whether you have any serious lung or heart disease because this will be important if you need to have surgery.
  • Computed tomography (CT or CAT) scan - Instead of taking one picture, like a conventional x-ray, a CT scanner takes many pictures as it rotates around you. A computer combines these pictures into an image of a slice of your body (like a loaf of sliced bread). CT scans are not usually used to diagnose endometrial cancer, but they are sometimes used to find out if the cancer has spread to other organs or has come back after treatment.  CT scans are also used to guide a biopsy needle into an area that could be cancerous.
  • Cystoscopy - The doctor examines the inside of the bladder and urethra (canal that carries urine from the bladder) with a cystoscope (a thin, flexible tube with a camera). A cystoscopy can show whether the cancer has spread to the bladder.
  • Intravenous pyelogram (IVP) - This is an x-ray of your urinary tract, which includes your bladder, ureters (tubes that connect the kidneys to the bladder), and kidneys. This test shows whether the cancer has spread to the urinary tract. However, CT scans can provide the same information and are used more often than IVP.
  • Magnetic resonance imaging (MRI) - This procedure uses powerful magnets and radio waves to take detailed cross-sectional images. MRI produces images of cross-sectional slices of your body like a CT scanner. It can also make images of slices that are parallel to the length of your body. MRI scans can be used to see whether the cancer has spread to the brain and spinal cord. They may also be useful for finding out whether and how far the endometrial cancer has grown into the body of the uterus. MRI scans are sometimes used to help find enlarged lymph nodes (small bean-shaped organs throughout the body that help fight infection).
  • Positron emission tomography (PET) - Cancer cells use glucose (sugar) more quickly than most other body organs. During a PET scan, the doctor injects a small amount of glucose that contains a radioactive atom into your arm. A special camera in the PET machine can detect the radioactivity. This test is sometimes useful to find out if your tumor is cancerous and whether the cancer has spread.
  • Proctoscopy (also called a sigmoidoscopy) - The doctor examines the colon and rectum using a sigmoidoscope (a thin, flexible tube with a camera) to see if the cancer has spread to the rectum.
  • Transvaginal ultrasound - Ultrasound, or ultrasonography, uses sound waves to produce images of internal organs, like the uterus. For transvaginal ultrasonography, a device (transducer) is inserted into the vagina and aimed toward the uterus. The transducer sends out sound waves and detects the echoes that bounce off internal organs. A computer processes the pattern of echoes to produce images of your reproductive organs (uterus, ovaries, cervix, and vagina) on a computer monitor. If the endometrium looks thick, the doctor will probably take a biopsy.

This content has been reviewed and approved by Myo Thant, MD.

This content was last reviewed August 15, 2010 by Dr. Reshma L. Mahtani.
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