How is endometrial cancer diagnosed?
You might have some or all of the following tests to confirm a diagnosis of endometrial cancer.
Note that a Cervical Screening Test does not detect cancer of the uterus. If you have recently had a Cervical Screening Test with a normal result, this does not mean that you do not have endometrial cancer. You should still have any symptoms checked by a doctor.
Your doctor will feel your abdomen, and may also do a vaginal or cervical examination (similar to having a Cervical Screening Test).
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 will suggest you have a biopsy.
An endometrial biopsy (also known as a pipelle biopsy) may be done by a gynaecologist 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. This cannot always be done (e.g. if the cervix is tightly closed).
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 remove tissue from the lining of the uterus for a biopsy. 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.
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. This process is called staging.
The results will help you and your doctor decide on the best treatment for you.
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.
A positron emission tomography (PET) scan (a type of nuclear imaging test) might also be requested.
These scans usually take a couple of hours, and you can usually go home as soon as the scan is over. Your doctor will give you information about what happens during the test and any preparation you need to do before the scan.
Women who are allergic to iodine may also be allergic to the dye used in a CT or MRI scan. The doctor, technician or nurse should be informed before the scan.
You may also have blood tests to assess your general health. The test results may help you to make treatment decisions.
Grading and staging
Knowing the grade and stage of the cancer helps you and your doctors to decide on the most appropriate treatment.
The grade of a cancer refers to how similar the cancer cells are to normal cells. Low-grade tumours tend to grow more slowly and are usually easier to treat. High-grade tumours grow faster and spread more quickly.
A pathologist grades endometrial cancer using cells or tissue from a biopsy.
The stage of a cancer refers to how far the cancer has spread. The staging system used for cancer of the uterus is the FIGO system, developed by the International Federation for Gynecology and Obstetrics:
- Stage 1 – the cancer is confined to the uterus.
- Stage 2 – the cancer has spread to the cervix.
- Stage 3 – the cancer has spread beyond the uterus and cervix to the ovaries, fallopian tubes, vagina or nearby lymph nodes.
- Stage 4 – the cancer has spread further, to the inside of the bladder or rectum, throughout the abdomen or to other body parts.