A woman presenting with abnormal vaginal bleeding, especially postmenopausal bleeding, requires a thorough investigation to confirm or rule out the diagnosis of uterine cancer. Early detection of endometrial cancer improves the chances of successful treatment of the disease. If detected early enough, complete cure is possible with appropriate treatment.
Diagnosis of Uterine Cancer
As with most conditions, diagnosis of uterine cancer starts with a thorough clinical history. A doctor will ask detailed questions about the symptoms, especially the abnormal vaginal bleeding. Other information that will be relevant includes menstrual history, number of pregnancies, medical history, family history, and other relevant information.
A physical examination is then, which includes a pelvic examination. If uterine cancer is suspected, the woman may be referred to a gynecologic oncologist (specialist in cancers of the female reproductive system).
Certain tests can help to confirm uterine cancer :
- Endometrial biopsy where a small piece of endometrial tissue is removed, which is then examined under the microscope to look for signs of abnormal cells that may be indicative of endometrial cancer. A biopsy is usually taken by introducing a thin flexible tube through the vagina and cervix to reach the endometrium. The results of an endometrial biopsy are usually conclusive.
- Dilation and Curettage (D&C) may be conducted if some doubts remain after an endometrial biopsy. This is usually done under general anesthesia as an outpatient procedure. An instrument (curette) is passed through the dilated cervix which scrapes a bit of tissue from the endometrium. The tissue is then examined under the microscope.
- Hysteroscopy is where a thin tube with a tiny camera and light source at its end (hysteroscope) assists with an endometrial biopsy or D&C . It affords good visualization of the inside of the uterus and allows endometrial tissue samples to be obtained with ease.
- Surgical staging is a post-operative diagnosis, where the tissue obtained after operation is examined for cancer. This is helpful in staging and grading of the cancer. Read more on uterine cancer grades and stages.
Other Uterine Cancer Tests
There are other tests which may be done, such as blood tests and imaging techniques, but none of these can conclusively confirm endometrial cancer. It may only be helpful in determining the extent of cancer in some cases and to assess if the patient is capable of undergoing treatment. These tests may also help in monitoring the efficacy of and response to treatment, as well as indicating cancer recurrence. Some of these tests include :
- Pap smear showing atypical endometrial cells may indicate the possibility of endometrial cancer but does not diagnose it conclusively.
- Routine blood tests, including cell count, liver and kidney function tests, and blood chemistry will be helpful in assessing the patient’s general health and ability to undergo surgery and other forms of therapy.
- Blood tests to check for the tumor marker CA 125, which is released into the blood stream by some ovarian and uterine tumors. This marker is non-specific for endometrial cancer, but a very high level may indicate the spread of cancer to other sites. By monitoring the level from time to time during treatment, the response to treatment may be assessed.
- Ultrasound may show the presence of tumor but the results are not always definitive. A transvaginal ultrasound or a hydroultrasound (saline solution used to expand the uterus for better visualization) may be done to look for abnormalities in the endometrium.
- CT scan or MRI may be done, especially for follow-up.
- Chest x-ray to look for lung metastasis.
- Bone scan in case of suspected metastasis to the bones.
Early Detection of Uterine Cancer
Early detection is only possible by being alert to the signs and symptoms suggestive of endometrial cancer, particularly in postmenopausal women. Read more on uterine cancer symptoms.
Finding atypical endometrial cells on routine pap smears may help to detect uterine cancer at an early stage.
Women at risk of hereditary nonpolyposis colon cancer (HNPCC) should undergo annual check-ups from the age of 35 onwards since they are at high risk of getting ovarian and uterine cancer. Hysterectomy with bilateral salpingo-oophorectomy (surgical removal of the uterus with removal of the fallopian tubes and ovaries on both sides) may be recommended for such high-risk women who no longer desire to get pregnant, to eliminate the chance of future cancer in these organs.