Diagnosing Endometrial Cancer

Your GP may do an internal vaginal examination after asking you some questions about your symptoms. You will have a nurse with you during this. The examination may be a little uncomfortable but should not be painful. Your GP will gently insert two fingers into the vagina whilst pressing on your tummy with the other hand to feel for anything unusual in the pelvis (lower part of the tummy). Your doctor may also insert a device called a speculum into the vagina to examine your vagina and neck of the womb (cervix).

An ultrasound may be recommended which looks at the thickness of the lining of the womb. This is usually a good indicator that something may be amiss if it is unusually thickened. A small probe is placed gently into the vagina and the scan only takes a few minutes. If it is not possible to do the scan through the vagina, it can be done over the tummy (abdomen), for which you will need a full bladder.

This is called a hysteroscopy and is another way to take a sample. Your doctor inserts a very thin, flexible tube with a light and camera on the end (hysteroscope) through the vagina and cervix into the womb. This is often done as an outpatient. Sometimes, local anaesthetic is used, but approximately a third of women will need a general anaesthetic as the procedure may be too uncomfortable for them. Pictures of the inside of your womb will show up on a screen for the nurse or doctor to review (you may get to see it too if you wish provided you have only received a local anaesthetic) and a biopsy from the womb lining will be taken.

You may be referred for an ultrasound scan of the womb (see below) or directly to a gynaecologist, a doctor who specialises in the health of the female reproductive system. You might be referred within 2 weeks for a clinic appointment depending on your symptoms. The gynaecologist will examine you again, including an internal examination.

This involves removing some tissue from the lining of the womb (a biopsy) to be looked at under a microscope for the presence of cancer cells. An endometrial biopsy can be taken in the clinic by passing a fine plastic tube (a pipelle) through the cervix into the womb and using gentle suction while you are awake. Some women can find this procedure uncomfortable, but this is usually well tolerated. This may not always be recommended and using a camera may instead be the best way of obtaining a biopsy (see below). This will then be examined by another specialist doctor (a pathologist) under the microscope to determine if cancer is present.

If endometrial cancer (and its type) is diagnosed from your biopsy by a pathologist, you will usually have further tests to find out more about the position of the cancer in your womb and if it has spread. The results will help your doctor make decisions about treatment. Tests include blood tests, a chest X-ray, a CT scan and an MRI scan. An MRI is more common provided there are no contraindications (e.g. you may have certain implants or may be claustrophobic). While CT scans check for potential spread of the cancer outside the pelvis, MRI scans are more commonly used to establish spread of the disease within the pelvis.