How is endometrial cancer diagnosed?
A doctor will usually do a vaginal examination if you have symptoms which may be due to cancer of the inside lining of the womb (uterus) - known as endometrial cancer. He or she may feel an enlarged uterus. It is likely you will need to have a further test to confirm the diagnosis - usually one of the following:
- Ultrasound scan of your uterus. This is usually the first test that is done. An ultrasound scan is a safe and painless test which uses sound waves to create images of organs and structures inside your body. It is most commonly used in pregnant women. The probe of the scanner may be placed on your tummy (abdomen) to scan the uterus. Sometimes a small probe is also placed inside your vagina to scan your uterus from this angle.
- Endometrial sampling. In this procedure, a thin tube is passed into your uterus. By using very gentle suction, small samples of your endometrium can often be obtained. This is done in the outpatient clinic, without an anaesthetic. The sample (biopsy) is looked at under the microscope to look for any abnormal cancer cells.
- Hysteroscopy. In this procedure, a doctor uses a hysteroscope, which is a thin telescope that is passed through the neck of your womb (cervix) into your uterus. The doctor can see the lining of your uterus and take samples of any abnormal-looking areas. This can also be done without an anaesthetic.
Once diagnosed, how is the extent of the cancer assessed?
If endometrial cancer is confirmed then further tests may be advised to assess if the cancer has spread. For example, a computerised tomography (CT) scan, a magnetic resonance imaging (MRI) scan, a chest X-ray, blood tests, an examination under anaesthetic of the uterus, bladder or rectum, or other tests. This assessment is called staging of the cancer. The aim of staging is to find out:
- How much the tumour has grown and whether it has grown to other nearby structures such as the neck of the womb (cervix), the bladder or the rectum.
- Whether the cancer has spread to local lymph glands (nodes).
- Whether the cancer has spread to other areas of the body (metastasised).
Finding out the stage of the cancer helps doctors to advise on the best treatment options. It also gives a reasonable indication of outlook (prognosis). See separate leaflet called Staging and Grading Cancer for more details.
Further reading and references
Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up; European Society for Medical Oncology (2013)
Morice P, Leary A, Creutzberg C, et al; Endometrial cancer. Lancet. 2015 Sep 4. pii: S0140-6736(15)00130-0. doi: 10.1016/S0140-6736(15)00130-0.
Wong AW, Lao TH, Cheung CW, et al; Reappraisal of endometrial thickness for the detection of endometrial cancer in postmenopausal bleeding: a retrospective cohort study. BJOG. 2015 Mar 20. doi: 10.1111/1471-0528.13342.
Kwon JS; Improving survival after endometrial cancer: the big picture. J Gynecol Oncol. 2015 Jul26(3):227-31. doi: 10.3802/jgo.2015.26.3.227.
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