Endometrial (Uterine) Cancer - Exams and Tests

Exams and Tests

Most cases of endometrial cancer are diagnosed in an early stage. This is because women who have reached menopause usually see their health professionals when they have vaginal bleeding. To check your symptoms, your health professional will perform a medical history and physical exam. The physical exam will include a pelvic exam and Pap test.

An endometrial biopsy is needed to confirm a diagnosis of endometrial cancer. A biopsy removes a small sample of the lining of the uterus (endometrium) for examination under a microscope.

Additional tests may include:

• A transvaginal pelvic ultrasound, which uses sound waves to create images of the uterus. The images can show how thick the endometrium is. A thick endometrium can be a sign of cancer in postmenopausal women. Ultrasound also can help show whether cancer has grown into the uterine muscle (myometrium).
• A hysteroscopy, which allows your doctor to view the inside of the uterus and obtain an endometrial tissue sample.
• Dilation and curettage (D&C), which is done to obtain a sample of tissue from the inside of the uterus. A D&C is sometimes done at the same time as a hysteroscopy.

Testing for endometrial cancer may show that you have endometrial hyperplasia. This is not cancer but may develop into cancer. One type of hyperplasia, atypical adenomatous hyperplasia, progresses to cancer in up to one-third of cases.⁷

Tests to determine the extent (stage) of endometrial cancer include:

Your doctor will determine the stage of your cancer at the time of your surgery. Other tests done before surgery may include:

• A complete blood count (CBC) to check for anemia and other abnormal blood values.
• A cancer antigen (CA) 125 test. The CA-125 test helps to identify cancer that has or may spread (metastasize).
• An intravenous pyelogram to check kidney function.
• A chest X-ray to check for cancer cells that have metastasized from the cervix.

An imaging test may be done before surgery to look for spread (metastasis) of cancer in the abdomen and pelvis. This helps with planning for treatment. Imaging tests include the following:

• A computed tomography (CT) scan of the abdomen and pelvis uses X-rays to make a picture of the inside of the body.
• A magnetic resonance imaging (MRI) of the abdomen and pelvis uses a magnetic field and pulses of radio wave energy to make pictures of the inside the body.

After endometrial cancer is confirmed, surgery is usually done to remove the uterus, cervix, ovaries, and fallopian tubes. This is called a hysterectomy with bilateral salpingo-oophorectomy. Sometimes the pelvic lymph nodes are also removed. The removed tissue is examined to determine the stage and grade of cancer.

Early Detection

There is no early detection test for endometrial cancer. If you have abnormal vaginal bleeding, schedule an appointment with your health professional for a medical evaluation. Unexpected bleeding, or more bleeding than normal, can be a symptom of endometrial cancer.

The American Cancer Society recommends that women nearing menopause learn about the risks and symptoms of endometrial cancer.⁶

• Women are advised to report to their health professionals any unexpected bleeding or spotting or unusual vaginal discharge.
• Women at risk for hereditary nonpolyposis colon cancer (HNPCC) are advised to get checked every year starting at age 35.⁶ These women also have a high risk of getting ovarian and uterine cancer. High-risk women who have no pregnancy plans can avoid these cancers by having the uterus, fallopian tubes, and ovaries removed. This is called a hysterectomy with bilateral salpingo-oophorectomy.⁸