To diagnose endometrial cancer, your doctor will first perform a pelvic exam. He or she may then conduct a transvaginal ultrasound examination. A special wand (called a transducer) is inserted into the vagina, and sound waves are emitted from the device and bounce off organs within the pelvis to help identify potential tumors. The transvaginal ultrasound is superior to a traditional abdominal ultrasound for uterine imaging because it enables the technician to place the transducer much closer to the uterus, thus allowing a more definitive diagnosis.
If it appears that an endometrial cancer might be present, your doctor will perform an endometrial biopsy, in which a sample of tissue is taken from the endometrium (the inner lining of the uterus) for examination under a microscope. A thin, flexible tube is inserted through the cervix into the uterus, and gentle scraping and suction are used to remove the sample.
For women who have been treated with tamoxifen, another diagnostic procedure known as sonohysterography may be used to find endometrial cancer. Used in conjunction with transvaginal ultrasound, sterile saline is infused into the uterus to expand the organ, allowing your doctor a clearer view of the inner cavity for examination.
During diagnosis, a hysteroscopy may also be performed to examine the inside of the uterus. During this procedure, a hysteroscope — a thin, lighted tube with a video camera on its tip — is inserted through the cervix and into the uterus. Tissue may also be removed for biopsy.
Dilation & Curettage (D&C)
If a diagnosis is not clear after these other tests, you may need to have an outpatient surgical procedure called dilation and curettage (D&C).
During this procedure, your doctor widens the cervix and gently scrapes tissue from inside the uterus. A D&C may require general anesthesia or conscious sedation (medication that reduces discomfort and anxiety without putting you to sleep). The procedure generally takes about an hour.
Once a sample of uterine tissue is obtained, the cells will be analyzed to determine if cancer is present. The cells may also be tested to see if they contain hormone receptors that may help slow the growth of cancer cells. For example, endometrial cancers that contain receptors for progesterone tend to grow and spread more slowly than cancers without these receptors.
Other Diagnostic Tests
Your doctor may perform other tests to determine if the cancer has spread beyond the uterus, including:
- CA-125 blood test to measure the level of CA-125 in the blood stream. CA-125 is a protein released by some endometrial and ovarian cancer cells. The test can be used to monitor the effectiveness of treatment and identify cancer recurrences.
- Cystoscopy (examination of the bladder using a lighted tube) to determine if the cancer has spread to the bladder.
- Proctoscopy (examination of the rectum using a lighted tube) to check for cancer in the rectum.
Other imaging tests can be performed, including CT scanning, MRI, chest x-ray, and an intravenous pyelogram (IVP), which is a series of x-rays of the urinary system (kidneys, ureters, and bladder) taken after a contrasting agent, or dye, is injected into a blood vessel.