|How Is Endometrial Cancer Diagnosed?
There is no routine screening test to discover endometrial cancer before symptoms develop. In fact routine pelvic examinations rarely uncover it. Most women are diagnosed because they tend to display symptoms of endometrial cancer, primarily abnormal vaginal bleeding. Fortunately it is highly curable if found in the early stages. The actual diagnosis of the cancer is similar to other gynecologic cancers like cervix, ovarian, vagina and vulva cancer. A physical examination and complete medical history will be taken by a doctor. A pap test is usually taken, although this is less useful than it is with cervical cancer diagnosis. If a doctor suspects endometrial cancer they should refer the patient to a gynecologist who is more qualified to diagnose and treat diseases of the female reproductive system. Specialists in treating reproductive organs are called gynecologic oncologists. To discover if cancer is present the doctor needs to perform an endometrial biopsy or dilation and curettage (D&C). Imaging scans and X-rays may be taken to discover the extent or staging of the disease. This is known as cervical cancer staging.
1. Physical Examination
The nurse or doctor will take a complete medical history and then carry out a physical examination of the vagina and genital area. They will look for the presence of abnormal vaginal bleeding or discharge. A bimanual exam helps to check the size, position and shape of the uterus. To do this, the practitioner will need to use both hands. Two fingers are inserted into the vagina while the other hand is used to apply pressure from the outside to flatten the ovaries and the uterus. The doctor may also carry out a Pap smear test.
2. Tissue Samples
A sample of endometrial tissue is necessary to help determine if cancer is present. A gynecologist or specialist usually carries out either an endometrial biopsy or dilation and curettage (D&C) with or without a hysteroscopy.
An endometrial biopsy is the most commonly performed test for this type of cancer and is highly accurate in postmenopause women. It does not require hospitalization and can be carried out in the doctor’s office. During the procedure a thin flexible tube is inserted into the uterus through the vagina. Using suction, a small amount of endometrium is removed through the tube. The suctioning takes about a minute. It may be slightly uncomfortable and cause some menstrual-like cramps. Taking an ibuprofen beforehand can minimize the effects. The results are sent to a lab for testing.
Using a tiny telescope inserted into the uterus through the vagina, hysteroscopy allows a doctor a better view of the uterus. The uterus is filled with gas or salt water, allowing the doctor to see better and biopsy anything abnormal. This is usually carried out with the patient awake using local anesthesia. It may also help to diagnose other conditions such as endometrial polyp, uterine fibroids and Asherman's syndrome.
Dilation And Curettage (D&C)
If the endometrial biopsy does not provide enough tissue or the results are not clear a D&C procedure will be performed in hospital under general anesthesia. The opening of the cervix is dilated and a special instrument is used to scrape tissue from inside the uterus. The procedure takes about an hour.
3. Imaging Tests
A transvaginal ultrasound can help assess bleeding in postmenopausal women by measuring the thickness of the uterine lining. A thicker lining is more common with cancer than a thinner (less than 5cm) one. A probe is inserted into the vagina which creates images of the uterus and other pelvic organs. The test is helpful when there are difficulties in examining the pelvic, for example in obese women. It can also help determine if a woman should have a D&C, which has possible risks associated with general anesthesia.
Cystoscopy & Proctoscopy
If it is suspected that cancer has spread to the bladder or rectum, either of these procedures may be performed, and involve inserting a tube with a camera to examine the organs internally. Small tissue samples may also be taken at the same time for testing in the lab. Both procedures can be performed under local anesthetic but some patients may need a general anesthesia. These tests were more common in the past but used less often today for diagnosing endometrial cancer.
Computed Tomography (CAT or CT Scan)
A CT scan is a sophisticated X-ray machine that takes cross-sectional images of the body. The patient lies on a table while the machine takes pictures. She may receive an IV line through which contrast dyes are injected. This helps to outline the organs of the body more clearly. A CT scan is not used for diagnosing endometrial cancer but it is helpful for endometrial cancer staging - that is, seeing if the cancer has spread to other parts of the body - or to see if cancer has recurred after treatment.
Magnetic Resonance Imaging (MRI Scan)
MRI scans use strong magnets and radio waves instead of X-rays. They are useful for giving detailed images of parts of the body, in particular the brain and the spinal cord. It may be useful in telling how far cancer has spread into the body of the uterus. It may also help find enlarged lymph nodes with a new technique that involves injecting tiny iron oxide particles into the vein which then settle in lymph nodes where they can be spotted. Patients can find MRI scans uncomfortable as it requires being placed inside a tube and the clicking noise of the machine can be disturbing.
Positron Emission Tomography (PET Scan)
This involves the use of radioactive glucose (sugar) which is given because cancer cells use glucose at a higher rate than normal cells. This means the glucose will be attracted to and settle in cancer cells. The PET scan will be able to pick up those deposits. A PET scan however is still not a routine part of endometrial cancer diagnosis.
A standard X-ray of the chest can show if cancer has spread (metastasis) to the area.
Complete Blood Count
A complete blood count (CBC) is also a regular part of any cancer diagnosis. It is a blood test that measures the different cells in the blood, including red and white blood cells and platelets. Very often women with endometrial cancer who have had a lot of abnormal bleeding will have a low red blood count (anemia).
CA 125 Blood Test
CA 125 is a protein released into the bloodstream by many endometrial and ovarian cancer. Very high levels of the substance suggest that endometrial cancer has spread beyond the uterus and has become invasive. Levels should drop after treatment of endometrial cancer, so it is sometimes used to testing the effectiveness of therapies.
Read about the risks of Endometrial Cancer Recurrence.
What causes it? Causes of Endometrial Cancer.
Can I protect myself: Endometrial Cancer Prevention.