Endometrial Cancer

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Cancer screening tests are performed when a person has no symptoms, like the annual mammograms for women 40 and over. But, unlike for breast cancer, screening for endometrial cancer is not recommended for most women because the chances of having endometrial cancer are quite low. But for women with Lynch syndrome (hereditary nonpolyposis colorectal cancer syndrome), an annual endometrial biopsy is recommended beginning at age 35. For women at normal risk for endometrial cancer, the best defense is to pay attention to their bodies, know the symptoms, and learn ways to decrease the chances of developing certain gynecological cancers.

If a woman is experiencing any irregular or postmenopausal vaginal bleeding or other symptoms of endometrial cancer, an endometrial biopsy should be done. An assessment of symptoms, risk factors, medical history, and a routine physical and pelvic exam will be performed. If you are pregnant or think you might be pregnant, or if you have recently been treated for a vaginal, cervical, or pelvic infection, the doctor should be informed.

Testing for endometrial cancer may include the following:

  • Endometrial biopsy
  • Dilation and curettage (D&C)
  • Hysteroscopy
  • Testing the tissue (pathology)
  • Other tests
  • Endometrial biopsy

    In an endometrial biopsy, tissue is removed from the endometrium by inserting a thin, flexible tube through the cervix and into the uterus. The person doing the biopsy removes a small amount of endometrial tissue through a thin tube, using suction. A pathologist views the tissue under a microscope to look for abnormal cells.

    The biopsy takes just a few minutes. Most women experience, at most, some mild discomfort, similar to menstrual cramps. If needed, local anesthetic may be used to numb the cervix, and taking ibuprofen before the test may help prevent pain.

    An endometrial biopsy can be somewhat more difficult and painful for older women because the vagina or cervix may not be very stretchable (elastic) or may have a small opening, which can make it difficult to insert the instruments.

    Most women experience little discomfort after this procedure and may resume normal activities. Intercourse, douching, taking a bath, and the use of tampons are usually not permitted for two days.

    Dilation and curettage (D&C)

    If the endometrial biopsy does not provide enough tissue or if a diagnosis of cancer is not definite, a dilation and curettage (D&C) may be done. Dilation and curettage is a surgical procedure in which the cervix is dilated. The surgeon passes a small instrument called a curette through the cervix into the uterus and scrapes off a sample of the endometrium. D&C takes about an hour and is usually done as an outpatient procedure under general anesthesia, so the woman will be unconscious and feel nothing. For a few hours after the procedure, she may experience mild pelvic cramping and a slight vaginal discharge. Also, the next menstrual period may be early or late. Most women are able to return to normal activities within one to two days. Intercourse, douching, and the use of tampons are usually not permitted for two weeks.

    Hysteroscopy

    Hysteroscopy is a diagnostic test that is used to determine if there are any structural problems inside the uterus. It can be done along with a D&C. The procedure uses a thin, telescope-like device called a hysteroscope. The hysteroscope is inserted into the uterus through the vagina and cervix. A liquid or gas may be released through the hysteroscope to expand the uterus so the inside can be seen more easily. A light in the hysteroscope allows the doctor to see the inside of the uterus and the openings where the fallopian tubes enter the uterine cavity. A hysteroscopy can help locate adhesions and abnormal growths. In addition to diagnosis, hysteroscopy can also be used to carry out procedures for treatment. If a surgical procedure is being done, tiny instruments will be inserted through the hysteroscope.

    A hysteroscopy may be done with local, regional, or general anesthesia depending upon whether other procedures are being done at the same time. Women may experience mild cramping or pain after the procedure. They may also have light vaginal bleeding and cramping for several days. Most women are able to return to normal activities within one to two days. Intercourse, douching, and the use of tampons are usually not permitted for two weeks.

    Testing the tissue (pathology)

    Once tissue is removed from the endometrium, a pathologist looks at it under a microscope to see if cancer cells are present. If cancer cells are present, the cells will be studied to learn more about the cancer and assign a grade of 1 to 3. Grade 1 refers to a well-differentiated tumor that is less aggressive. Grade 3 refers to a poorly differentiated tumor that may act aggressively. Read more about grading in the section on treatment.

    Other Tests

    If the cancer appears to be more advanced, doctors may recommend additional diagnostic testing. These tests may include:

    • Chest X-ray: This is a picture of the chest that shows your heart, lungs, airway, blood vessels, and lymph nodes. A chest X-ray is performed to see if the endometrial cancer has spread to the lungs. It also shows the bones of your spine and chest, including your breastbone, ribs, collarbone, and the upper part of your spine. A chest X-ray is the most common test used to find problems inside the chest with the organs and structures. Usually two pictures are taken, one from the back of the chest and another from the side. However, doctors cannot always get the information they need from a chest X-ray to find the cause of a problem.
    • Complete blood count: Blood tests will be conducted to ensure that individuals can safely undergo surgery. Many times, women who have lost blood from the uterus will have low red blood cell counts.
    • Though uncommon, other tests may include:

      • Computerized tomography (CT) scan: This is a diagnostic test that uses an X-ray machine and a computer to create detailed pictures of the body, including 3-D images. It is used to detect disease or abnormal organ structure. CT scans can also be used to guide a biopsy needle into a mass.As part of a CT scan, you may be asked to drink contrast liquid or have an IV (intravenous) line for injection of a contrast dye. Contrast dye makes your organs more visible on the X-ray film.
      • Magnetic resonance imaging (MRI): a diagnostic test that uses magnetic fields and radio (sound) waves to create computerized images of the brain, spine, bones, and soft tissue such as organs, muscle, cartilage, ligaments, and tendons. You may have to be placed in a tube, which can feel confining and upset people with a fear of enclosed spaces. A contrast dye might be used. The MRI is very noisy while it is operating, so patients are usually given ear plugs.
      • CA 125 blood test: This test measures the amount of a protein (CA 125) found on the surface of many endometrial and ovarian cancers. High levels of this protein may suggest that the cancer has spread beyond the uterus.
      • Last reviewed on 10/13/09

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