Diagnosing Endometrial Cancer

Doctors at NYU Langone are experienced in diagnosing endometrial cancer. This cancer begins in the endometrium, the lining of a woman’s uterus, or womb—the pear-shaped organ where a baby develops during pregnancy. Endometrial cancer is the most common type of cancer affecting a woman’s reproductive system.

Most women with endometrial cancer experience some kind of abnormal vaginal bleeding: bleeding between menstrual periods, unusually heavy menstrual periods, or bleeding after menopause. Some women experience other symptoms, such as pelvic pain or pain during intercourse or urination.

Risk Factors

Endometrial cancer occurs most often in women between the ages of 50 and 60. Nearly half of women who are diagnosed with this cancer have obesity, meaning they have a body mass index—a ratio of weight and height—of 30 or higher.

Fat cells produce excess estrogen, a hormone that increases the risk of endometrial cancer. Women with obesity may have up to four times the risk of developing endometrial cancer than women of normal weight. Endometrial cancer is also more common in women who have conditions associated with obesity, such as type 2 diabetes and polycystic ovarian syndrome.

Women who began menstruating before age 12 and stopped having menstrual cycles relatively late in life have a higher risk of developing endometrial cancer. This is because they have been exposed to estrogen for a longer period of time. Women who have never been pregnant, and haven’t experienced the temporarily lower estrogen levels associated with pregnancy, are at higher risk.

Other conditions that raise the risk of developing this type of cancer are endometrial polyps, noncancerous growths such as cysts, and endometrial hyperplasia, which is a thickening of the endometrium that may be precancerous.

Women who take the medication tamoxifen for the prevention or treatment of breast cancer and those who use estrogen replacement therapy to combat symptoms of menopause may also have a higher risk of developing endometrial cancer.

However, women who have taken combination oral contraceptives, or birth control pills, that contain the hormones estrogen and progestin, may have a lower risk. This is because progestin combats estrogen-fueled cell growth and protects the lining of the uterus. This protective effect increases with the length of time you use these contraceptives and continues for many years after you stop taking birth control pills.

The risk of endometrial cancer is higher in women who have Lynch syndrome, which is caused by several gene mutations that increase the risk of many cancers, including colorectal and ovarian cancer.

NYU Langone doctors use several tests to diagnose endometrial cancer or to look for precancerous cells, which are cells that have undergone changes that often precede cancer development.

Pelvic Exam

Having a yearly pelvic exam may alert your doctor to symptoms, such as unusual vaginal bleeding, that may warrant diagnostic testing.

During a pelvic exam, your gynecologist may perform a screening test, also known as a Pap test, for cervical cancer. In this test, the doctor uses a small brush to gently scrape cells from the vagina and cervix, which is the bottom portion of the uterus.

A pathologist, a doctor who looks at tissue samples to identify abnormalities, examines the cells under a microscope to look for any precancerous or cancerous changes. Although this test is not performed to screen for endometrial cancer, it may indicate the presence of abnormal endometrial cells, prompting additional testing.

Endometrial Biopsy

Your NYU Langone doctor may perform an endometrial biopsy if you have abnormal bleeding or if your Pap test leads to the discovery of precancerous endometrial cells.

In this test, the doctor inserts a very thin, flexible tube called a catheter through the vagina and into the uterus. A small amount of the endometrium is suctioned out and later examined by a pathologist to look for precancerous or cancerous cells.

The procedure is performed in the doctor’s office using local anesthesia. It can be completed in fewer than 10 minutes.

Endometrial biopsy results are often very informative. However, because the biopsy samples are taken from a random place in the uterus, they occasionally fail to detect precancerous or cancerous growths.

In some instances, fibroids—noncancerous growths in the wall of the uterus—may obstruct the entrance to the uterus, preventing the doctor from obtaining an adequate biopsy sample.

Transvaginal Ultrasound

If your symptoms persist and the results of an endometrial biopsy do not reveal any precancerous or cancerous cells, your doctor may perform a transvaginal ultrasound. This test uses sound waves to create computerized images of the uterus, ovaries, and fallopian tubes.

Transvaginal ultrasound allows your doctor to look for signs of endometrial hyperplasia, a thickening of the lining of the uterus that can lead to cancer. It may also be performed when you have had an abnormal Pap test result, abnormal bleeding, or other symptoms.

In this test, conducted at the doctor’s office, a wand called a transducer is inserted into the vagina to create an image that allows the doctor to measure the thickness of the endometrium.

Hysteroscopy with Dilatation and Curettage

Your doctor may perform a hysteroscopy with dilatation and curettage if the results of an endometrial biopsy are inconclusive or the doctor couldn’t obtain enough tissue for a biopsy.

First, the doctor widens the opening of the cervix with thin, metal rods called dilators. Then, he or she inserts a hysteroscope—a thin tube with a tiny camera on the end—into the uterus through the cervix. This allows the doctor to view the uterus for growths or signs of endometrial hyperplasia and to determine which area of the uterus to remove for a biopsy.

The doctor then inserts an instrument called a curette to remove a small amount of endometrial tissue for examination under a microscope. Different instruments may be used to remove endometrial tissue, as needed.

A pathologist who specializes in detecting changes in uterine tissue can determine if your endometrium contains precancerous or cancerous tissue. If the endometrium contains growths, the pathologist can determine if cancer is present.

If the growth is cancerous, the pathologist identifies the tumor’s risk of growing and spreading. This information, along with details about the tumor’s size and degree of invasion into the uterine muscle wall, is used to determine the cancer’s risk of spreading.

Hysteroscopy with dilatation and curettage is a minor surgical procedure performed in the hospital at NYU Langone. It requires either epidural anesthesia, which blocks pain below the waist, or general anesthesia. It usually lasts less than 30 minutes, and most women return home the same day.

Additional Imaging Tests

If a biopsy confirms that you have endometrial cancer, imaging tests may be performed to determine the size of the tumor and if the cancer has spread. Doctors may recommend a CT scan, a type of X-ray that uses a computer to create cross-sectional, three-dimensional pictures of the uterus. They may also suggest an MRI scan, which uses a magnetic field and radio waves to create computerized, three-dimensional images of soft structures in the body.

Before a CT or MRI scan, a contrast agent or dye that enhances the image may be injected into a vein or given to you by mouth.

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