A diagnosis of endometrial cancer will likely start with a visit to your primary care physician, who will obtain a thorough medical history and then perform a physical examination. In addition, he or she will then utilize any of the following tools to arrive at a diagnosis:
A pelvic exam may be the first more directed physical exam performed for a patient. During this procedure, you will be asked to lie on your back, place your legs in a stirrup-type device and then slide to the end of a table. Then, the physician will examine the appearance of the vagina. Afterwards, he or she will insert a device called a speculum into the vagina to allow visualization of the inner walls of the vagina and the cervix.
A Pap smear, or Pap test, will also be done. During a Pap smear, the physician will use a brush-like tool to collect cells from the surface of the cervix. The collected cells will then be analyzed under a microscope to ensure there are no cancerous changes on the cervix, which may suggest cervical cancer.
In addition, a bi-manual exam will may be performed, which entails placing two fingers inside the vagina and then using the other hand to feel, or palpate, for masses or tenderness in the lower abdomen and pelvis. Finally, your physician may elect to do a rectovaginal exam, which involves placing a finger in the anus and vagina to feel for masses or any other abnormalities, which may involve the back, or posterior, part of the uterus and rectum.
A pelvic ultrasound may also be used to assess the uterine cavity and look for any abnormalities. During this procedure, a probe called the transducer is placed on the lower abdomen and then sound waves are used to generate images on a screen and to help identify masses or injuries to organs. It utilizes no radiation, unlike many other imaging modalities, like x-rays or CT scans. A transvaginal ultrasound, or TVUS, requires the probe be placed inside the vagina and yields more accurate images of the inside of the uterus.
If any of the above exams are abnormal, your physician may elect to perform an endometrial biopsy. An endometrial biopsy is the most commonly performed test for women with endometrial cancer. It is most often performed in the doctor’s office and is only slightly uncomfortable (many women compare the pain to menstrual cramping). Ibuprofen or non-steroidal anti-inflammatories (NSAIDs) can further reduce pain if taken prior to the biopsy. During this procedure, a small, narrow tube is inserted through the cervix and then used to suction small amounts of endometrial tissue, which is then assessed under the microscope. A pathologist will then study the biopsy to determine if the mass is benign or malignant and will then identify the exact type of malignancy.
Your physician may also perform a hysteroscopy, which utilizes a small camera to visualize the inside of the uterus. After a small amount of local anesthesia is placed in the cervix, the camera is inserted through the cervix and into the uterus. Then, saline is used to fill the uterus, which helps to provide a clear image and assess for the presence of abnormal tissue or masses.
If the endometrial biopsy does not provide adequate tissue or a diagnosis is uncertain, your physician may elect to do a dilation and curettage, or D&C. During this procedure, you are either under general anesthesia, conscious sedation, and/or with local anesthesia in an outpatient surgical center. Once comfortable, the physician will dilate the cervix and then use a small instrument to remove endometrial tissue, which can then be assessed for abnormal or cancerous cells and hopefully allow a certain diagnosis.
If it is suspected that the cancer has spread beyond the uterus or the physician desires a sharper image of the uterus, he or she may order a CT scan, which uses x-rays to generate an image. It will show the precise location, shape, and size of masses. In order to obtain even sharper images, some patients are asked to drink or receive IV contrast. This contrast makes some tissues appear brighter, which makes the images and the structures more apparent and easier to discern. Allergies to contrast medium may cause hives, flushing, shortness of breath, and low blood pressure. If you have had a reaction to contrast before, you should inform your physician. In addition to masses (such as cancers), it can show enlarged lymph nodes, which may have cancer cells. Many patients will have CT scans of the chest, as well as the abdomen to look for cancer spread, which may involve the liver, adrenal glands, or other internal organs. The CT scan may also involve the brain to look for cancer metastasis. A CT scan may also be used to obtain biopsies of masses or cancers what lie deep within or nearby other vital structures, which is termed CT guided needle biopsy.
A magnetic resonance imaging (MRI) study also provides detailed soft tissue “pictures.” As opposed to CT scans, which utilizes x-rays, MRIs use magnetic radio waves to generate images. MRIs are particularly useful for imaging the brain and spinal cord. Gadolinium, a contrast, is often used to produce even better MRI images.
PET scans, also known as positron emission tomography, are especially useful to look for cancer spread. This study involves injecting a special radioactive sugar (flourodeoxyglucose, or FDP) into the vein. The amount of radioactivity is very low and will not cause you harm. After the injection, a special scanner will pickup areas in your body where the sugar has accumulated. As cancer cells are very active and require a great amount of energy (sugar), the FDP will concentrate in these areas. The PET scan does not produce extremely detailed images, but rather indicates spread of cancer throughout the body.
Bone scans can also be performed to detect spread of cancer to bones. During this procedure, a radioactive dye is injected in the vein, where is it transported to areas of bone with abundant activity, which may occur in cancerous and non-cancerous states.
A simple chest x-ray or radiograph will usually be performed, as it is convenient, cheap, and will reveal if the cancer has progressed to the lungs.
Possible lab tests used to diagnosis endometrial cancer include a CBC, or complete blood count. As bleeding is a common symptom, a low red blood cell count may be found. Also, a CA-125 level may be ordered. This is a substance often times found elevated in endometrial or ovarian cancers. As this test is not required for a diagnosis of endometrial cancer, it is not ordered on all patients.