How is endometrial cancer diagnosed?

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You might have some or all the following tests to confirm a diagnosis of endometrial cancer. 

Once endometrial cancer is suspected, you should be referred to a gynaecologic oncologist. This is a doctor who has specialist training in cancer of the female reproductive system. 

Physical examination and medical history

A doctor will check your body to look for lumps and other signs of cancer, especially around your belly. They may also do a vaginal or cervical examination. They will also ask you about your medical history. 

Transvaginal ultrasound

This test uses sound waves to create a picture of internal organs. A small device called a transducer is put into your vagina. It makes sound waves and receives echoes. A computer creates a picture based on the echoes produced when sound waves meet something dense, such as an organ or tumour. 

Using the ultrasound, the doctor can look at the size of your ovaries and uterus and the thickness of the endometrium (the lining of the uterus). If anything appears unusual, the doctor may suggest you have a biopsy. 

Endometrial biopsy

Your doctor may do an endometrial biopsy (also known as a pipelle biopsy) to examine the cells of your endometrium. A narrow plastic tube that removes a small sample of endometrial cells using suction is inserted into the uterus. 

An endometrial biopsy might be done at the same time as a hysteroscopy. 

Hysteroscopy and biopsy

A hysteroscopy allows your doctor to see inside your uterus by inserting a telescope-like device called a hysteroscope through the cervix. At the end of the procedure, the doctor will remove some tissue to send to a pathologist for examination under a microscope. This is called a biopsy. 

Dilation and curettage

A dilation and curettage (D&C) is the most common and accurate way to biopsy tissue from the lining of the uterus. The general steps are: 

  1. The cervix (the opening of the uterus) is dilated (made larger). 
  2. The material inside the uterus is removed with a small vacuum-like device. 
  3. The walls of the uterus are then scraped gently to remove any material that may remain in the uterus. 

It is usually done along with a hysteroscopy, and takes a few hours in hospital or at a day procedure clinic under a light general anaesthetic. 

Period-like cramps and light bleeding may occur after the D&C and can last for a few days. 

Further tests

Even after a diagnosis is made, further tests are often needed to determine the size and position of the cancer, and whether it has spread (see Staging and grading). 

The results will help you and your doctor decide on the best treatment for you. 

X-rays

You may have a chest X-ray to check that your lungs and heart are healthy. 

CT, MRI or PET scans

Computerised tomography (CT) or magnetic resonance imaging (MRI) scans allow doctors to see pictures of the organs and other structures (including tumours) in your body. They are usually done at a hospital or radiology clinic. 

Your doctor may also ask for a positron emission tomography (PET) scan (a type of nuclear imaging test). Before the scan, you will be injected with a liquid that contains a small amount of radioactive material. This takes 30–60 minutes to spread throughout your body. Cancerous cells will take up more of the liquid than normal cells and will appear brighter in the scan. 

Blood tests

You may also have blood tests to assess your general health. The test results may help you to make treatment decisions. 

Staging and grading

The stage of a cancer is a term used to describe its size and whether it has spread beyond its original area of the body. 

The grade of a cancer describes how quickly the tumour is likely to grow. 

Knowing the grade and stage of the cancer helps doctors decide on the most appropriate treatment. 

Staging

The stage of a cancer is a term used to describe its size and whether it has spread beyond its original area of the body. The staging system used for cancer of the uterus is the FIGO system, developed by the International Federation for Gynecology and Obstetrics: 

  • Stage I – the cancer is confined to the uterus. 
  • Stage II – the cancer has spread to the cervix. 
  • Stage III– the cancer has spread beyond the uterus and cervix to the ovaries, fallopian tubes, vagina, abdominal tissues or nearby lymph nodes. 
  • Stage IV – the cancer has spread further, to the inside of the bladder or rectum, throughout the abdomen or to other body parts. 

Grading

Grading refers to the appearance of the cancer cells under the microscope and gives an idea of how quickly the cancer may develop. 

Low grade means the cancer cells look like normal cells. They are usually slow growing and are less likely to spread. 

High grade means the cells look very abnormal. They are likely to grow more quickly and to spread. 

A pathologist grades endometrial cancer using cells or tissue from a biopsy.