Uterine (Endometrial) Cancer Screening and Diagnosis

Accurate diagnosis and staging for uterine cancer.

Uterine cancer is the most common cancer of the female reproductive system. Each year, there are about 26 new cases of the disease for every 100,000 women. The cancer develops in the area where a baby grows, the uterus. Most uterine cancers stay in the uterus. 

There are two main types of uterine cancer: 

• Endometrial cancer (also called adenocarcinoma of the endometrium) is the most common uterine cancer. The disease develops in the lining of the uterus, and it is related to changes in hormone levels.
• Uterine sarcoma forms in the tissues or muscles of the uterus, and it is a rare type of cancer. 

Signs and symptoms of uterine (endometrial) cancer

Uterine cancer causes symptoms that often appear in the early stages of the disease. They include:

• Bleeding after menopause 
• Bleeding after intercourse or between periods
• Pain in the pelvic area
• Pain during sexual intercourse
• Pain or difficulty when urinating
• Discharge that is watery, bloody, or strong smelling
• Frequent urination

At Henry Ford, we recommend that you see your doctor as soon as possible if you have bleeding that is not normal for you, or if you have any of the symptoms for two weeks or longer.

Many symptoms may be like other medical concerns. Your doctor can determine if any abnormal cells are in the precancerous or cancerous stage. When diagnosed with cancer in the early stages, treatment is often the most effective. 

Risk factors for uterine (endometrial) cancer

Certain factors may increase the risk of uterine cancer. However, having several risk factors does not always cause uterine cancer. These are the most common risk factors.

• Drugs that affect hormone levels, such as tamoxifen and estrogen replacement therapy
• Number of menstrual cycles, pregnancies, and ovarian tumors
• Being aged 60-70
• Obesity or high fat diet, which increases estrogen levels
• Diabetes
• Cancer of the breast or ovaries
• Radiation treatment to the pelvic area for other cancers 

Diagnosing uterine (endometrial) cancer

While there is no standardized uterine (endometrial) cancer testing or screening for patients, your doctor might find a suspicious cells or evidence of cancer through one of the following ways:

Medical history: You will be asked about your family, any pregnancies, and sexual history. Please be honest and open with your doctor. We are here to help you. We are not here to make judgments.

Physical exam: The doctor will press on your abdomen to feel for lumps in the vagina. Also, your breasts and glands may be checked for lumps.

Pelvic exam: Your doctor will examine the outside and inside of your vagina to check for lumps or sores that may signal cancer.

Pap test: During a pelvic exam, cells from the cervix and vagina will be swabbed and sent to a lab to be examined under a microscope to look for signs of cancer. A Pap test is used mainly to check for cervical cancer, but sometimes abnormal glandular cells caused by cancer growing in the uterus may be found.

Pelvic ultrasound: Images of the pelvic organs are obtained by using sound waves. A non-greasy gel is applied to the skin and a hand-held probe (transducer) is moved across the abdomen. In pregnant women, ultrasound is used to check the health of an unborn baby. In women suspected of uterine cancer, ultrasound can help diagnosis pelvic masses, fibroids, and other problems. 

Transvaginal ultrasound: This exam also uses high-energy sound waves to bounce off tissues and organs and make echoes. Then images, called sonograms, are obtained of the ovaries, uterus, and lining of the uterus. Either you or a sonographer will place a probe covered with a sheath and non-greasy gel in your vagina. The sonographer will move the probe to obtain the best images. You may feel some pressure. If you feel pain, tell the sonographer.

Hysteroscopy: This procedure is usually done on an outpatient basis. After you’ve been given a numbing medication, a tiny telescope will be inserted through the cervix and into the uterus. Then the uterus will be filled with salt water so your gynecologist can see cells or polyps that look unusual. 

Biopsies

If the Pap test or hysteroscopy show abnormal cells, a biopsy will be required to remove and examine cells for uterine cancer. This is the only way to confirm the disease. 

There are two types of biopsies that diagnose uterine pre-cancer and cancer. Sometimes a biopsy can completely remove all the abnormal tissue, and it may be the only treatment required. 

• Endometrial biopsy: This is an outpatient procedure. Before the biopsy, a local anesthetic will be injected into the cervix. Then a thin and flexible tube will be carefully inserted through the cervix and into the uterus. A small amount of endometrial tissue will be suctioned through the tube for about a minute or less. Discomfort may be similar to menstrual cramps.
• Dilation and curettage (D&C): For this procedure, you will be asleep or receive medicine to make you feel drowsy and then a local anesthetic will be injected into the spine. The opening of the cervix will be dilated, or enlarged. Next, an instrument called a curette will be used to scrape tissue samples from the inside of the uterus. After the procedure, many women report having little discomfort.

If the biopsy shows uterine cancer is present and it may have spread to other areas of the body, more tests will be done. It is important to know where the cancer cells have moved to create a personalized treatment plan.

Diagnosing uterine (endometrial) cancer 

These imaging tests will help determine the location of the cancer cells that may have moved outside of the uterus. 

• Computed tomography (CT): Using a computer, detailed and cross-sectional images of the pelvic area are made quickly with x-rays taken at various angles. Dye may be injected into a vein or given orally to help tissues and organs show up in the image. The images may show enlarged nodes or signs that the cancer has spread to the abdomen or other areas.
• Positron emission tomography (PET) scan: During this procedure, glucose (sugar) is mixed with a very small amount of a radioactive substance and injected into a vein. As you rest on a table, the solution is absorbed by certain organs and tissues. Then you will be moved into a tunnel scanner. The PET scanner traces the flow of the solution inside your body to find cancer cells. Those cells use more glucose than normal cells and show up brighter in the images.
• Magnetic resonance imaging (MRI): Strong magnets, radio waves, and a computer are used to make detailed pictures of certain areas of your body. The test may be able to pinpoint if cancer cells have spread to the rectum, bladder, or other organs. Before the imaging begins, a contrast dye may be injected into a vein. This painless procedure involves resting on a table and sliding into a tunnel-shaped scanner for 30-60 minutes while pictures are taken. No radiation is used.
• Cystoscopy: If you have symptoms that the cancer has spread to your bladder, this procedure may be done to look inside the urethra, which is the narrow tube that allows urine to drain from the bladder. A thin instrument is inserted through the urethra into the bladder. Tissue samples may be removed by a tool on the cystoscope.  
• Ureteroscopy: At the same time that a cystoscopy is done, another procedure called a ureteroscopy may be done if your symptoms suggest that the cancer has spread to your bladder. During this procedure, a ureteroscope with a light and lens for viewing will look inside the two ureters – the thin tubes that lead from the kidneys to the bladder. Tissue may be removed to be checked for signs of cancer.
• Colonoscopy: If you have symptoms that the cancer has spread (metastasized) into your colon, your doctor will want you to have a colonoscopy. You will be sedated for this procedure. A thin, flexible and lighted tube with a small video camera on the end is inserted through the anus. During the procedure, the doctor can remove any cancerous cells. 
• Barium enema x-ray: For this x-ray, liquid is inserted into your rectum through a narrow tube and then images are taken of the colon. A specially trained doctor called a radiologist will look for signs that uterine cancer may have spread to the colon.
• Chest x-ray: In some cases, a chest x-ray may be required to determine if uterine cancer has moved (or metastasized) to the chest.

Stages of uterine (endometrial) cancer

Your physical exam, biopsies, imaging, and other tests help your doctors find exactly where the cancer is located and the amount of it in the body. This process is called staging. 

Part of this process involves a specially trained physician called a pathologist. The pathologist will study the cells taken during the biopsy. The size, shape, and appearance of the cells help to identify the stage of cancer. Then your gynecologist and the tumor board will determine additional treatment options. 

There are four stages of uterine cancer.

Stage 1: Cancer is the uterus only. 
Stage 2: Cancer has spread to the cervix.
Stage 3: Cancer has spread to the vagina, ovaries, or lymph nodes. 
Stage 4: Cancer has spread to the bladder, rectum, organs, or bones far from the uterus.