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Tests and diagnosis
By Mayo Clinic staff
Your gynecologist or your primary care doctor will conduct a complete medical history and perform a physical and pelvic examination. During the pelvic examination, the doctor feels for any lumps or changes in the shape of the uterus that may indicate a problem.
Diagnosis may or may not involve these other tests:
- Transvaginal ultrasound. Your doctor may recommend a transvaginal ultrasound to look at the thickness and texture of the endometrium and help rule out other conditions. In this procedure, a wand-like device (transducer) is inserted into your vagina. The transducer uses sound waves to create a video image of your uterus. This test helps your doctor look for abnormalities in your uterine lining, and it may be done prior to an endometrial biopsy to locate suspicious-looking tissue.
- Endometrial biopsy. To get a sample of cells from inside your uterus, you'll likely undergo an endometrial biopsy. This involves removing tissue from your uterine lining for laboratory analysis. This may be done in your physician's office and usually doesn't require anesthesia. Because of the increased risk, women who have HNPCC mutations should talk with their doctors about yearly endometrial biopsies beginning around age 35.
- Dilation and curettage (D and C). If enough tissue can't be obtained during a biopsy or if the biopsy suggests cancer, you'll likely need to undergo a D and C. In this procedure, which requires you to be in an operating room under anesthesia, tissue is scraped from the lining of your uterus and examined under a microscope for cancer cells.
- Pap test. Your doctor takes a sample of cells from the cervix, the lower, narrower portion of the uterus that opens into your vagina. Doctors use the Pap test to detect another type of cancer — cervical cancer. Because endometrial cancer begins inside your uterus, it's rarely detectable by a Pap test.
If endometrial cancer is found, you'll likely be referred to a gynecologic oncologist — a doctor who specializes in treating cancers involving the female reproductive system. You'll need more tests (staging) to determine if the cancer has spread (metastasized) to other parts of your body. These tests may include a chest X-ray, a computerized tomography (CT) scan and some blood tests.
In endometrial cancer, final staging is done through a surgical procedure and is done at the same time as any surgical treatment:
- Stage I cancer is found only in your uterus and hasn't spread.
- Stage II cancer is present in both the body of your uterus and in your cervix. In this stage, cancer is no longer confined to the uterus, but hasn't spread beyond the pelvic region.
- Stage III cancer has not involved the rectum and bladder, though pelvic area lymph nodes may be involved.
- Stage IV cancer is the most serious and means that the cancer has spread past the pelvic region and can affect the bladder, rectum and more distant parts of your body.
- Detailed guide: Endometrial cancer. American Cancer Society. http://documents.cancer.org/140.00/140.00.pdf. Accessed Sept. 9, 2008.
- Endometrial cancer treatment (PDQ). National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/treatment/endometrial/patient/allpages/print. Accessed Sept. 16, 2008.
- Bakkum-Gamez JN, et al. Current issues in the management of endometrial cancer. Mayo Clinic Proceedings. 2008;83(1):97-112.
- Sorosky JI. Endometrial cancer. Obstetrics and Gynecology. 2008;111(2, Part 1):436-447.
- Moynihan T (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 21, 2008.
