Testing for Endometrial Cancer
If your doctor suspects you have endometrial cancer, there are several tests that may be performed to make a diagnosis and determine the extent of the cancer.
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To find out whether you have endometrial hyperplasia or endometrial cancer, your doctor must remove some tissue so that it can be looked at under the microscope. Tissue can be taken out by doing an endometrial biopsy or by a D & C (dilation and curettage).
This kind of biopsy can be done in a doctor's office. A very thin, flexible tube is placed into the uterus through the cervix. Then suction is used to remove a small amount of endometrium. The suction usually takes less than a minute. The discomfort is much like menstrual cramps and can be helped by taking a drug like ibuprofen before the test.
This is a way that doctors can look inside the uterus. The doctor puts a tiny telescope into the uterus through the cervix. The uterus is then filled with salt water (saline). This lets the doctor see and take a sample of anything that might be causing a problem, such as a cancer or a polyp. You stay awake for this, and the biopsy is done after the area is numbed with medicine.
Dilation and curettage (D & C)
If the biopsy sample doesn't get enough tissue, or if the doctor can't tell for sure whether it is cancer, a D & C must be done. To do this, the cervix is opened (dilated) and a special instrument is used to scrape tissue from inside the uterus. The test takes about an hour and you may need medicine to make you sleep (general anesthesia). D & C is most often done in an outpatient surgery area of a clinic or hospital. Most women have little pain after this procedure.
Testing the tissue
Tissue that has been removed is looked at under a microscope to see whether there are cancer cells in it. If cancer is found, the cells will be studied to learn more about the cancer. The lab report will give these details.
The lab will also assign a grade to the cancer. If most of the cancer cells look like normal tissue, it's given a grade 1. If most of the cells look very different from normal cells, it's given a grade of 3. Grade 2 tumors fall somewhere in between. The grade is important because women with lower-grade cancers are less likely to have advanced disease or to have the cancer come back after treatment.
Imaging tests for endometrial cancer
Ultrasound is the use of sound waves to take pictures of the inside of the body. For this test, a probe is placed into the vagina. It gives off sound waves that echo off the tissue of the pelvic organs to create a picture on a video screen. This test can be used to see if there is a tumor. It could also show whether the tumor is growing into the outer muscle layer of the uterus. Salt water (saline) might be put into the uterus before the test to give a clearer picture.
Cystoscopy and proctoscopy
If a woman has signs that suggest the endometrial cancer may have spread, the doctor can use a lighted tube to look at the inside of the bladder or rectum. Small pieces of tissue can be removed to be looked at under a microscope.
This is a special type of X-ray that creates detailed pictures of the inside of the body. CT scans are rarely used to find endometrial cancer. But they may be helpful if it looks as if the cancer has come back or has spread into the liver or other organs. CT scans can also be used to guide a biopsy needle into the area that could be cancer.
CT scans take longer than regular X-rays. You will need to lie still on a table while the scans are done. You may also have an IV (intravenous) line through which a contrast "dye" is injected. Some people are allergic to the dye and get hives or, rarely, problems like trouble breathing and low blood pressure. Be sure to tell the doctor if you have ever had a problem from any dye used for X-rays. You may also be asked to drink one to two pints of a liquid that helps outline the intestine so that it is not mistaken for tumors.
MRI scan (magnetic resonance imaging)
MRI scans use radio waves and strong magnets instead of X-rays. MRI scans are helpful in looking at the brain and spinal cord. They take longer than CT scans, and you may have to be placed inside a tube-like machine. This can be upsetting for some people. Sometimes newer "open MRI" machines are used. The machine makes thumping or buzzing noises that you may find disturbing. Many places will give you headphones with music to block this out. A contrast dye might be used, just as with CT scans.
PET scan (positron emission tomography)
In this test, a type of radioactive sugar is given to look for cancer cells. The cancer cells take in large amounts of the sugar. A special camera can then detect where it goes in the body. PET is sometimes useful in finding small collections of cancer cells. But PET is not often used for endometrial cancer.
This can show if the cancer has spread to the lungs. It may also be used to look for serious lung or heart problems.
IVP (intravenous pyelogram)
An IVP may be done if the doctor thinks the endometrial cancer might have spread to the urinary tract or nearby tissues. An IVP is an X-ray that outlines the urinary system. But CT scans are used more often than IVP.
Complete blood count (CBC)
This test measures the different cells in the blood, such as the red blood cells, white cells, and platelets. Many times women who have lost blood from the uterus will have low red blood cell counts. This is called anemia.
CA 125 blood test
CA 125 is a substance that many endometrial and ovarian cancers release into the bloodstream. Very high blood CA 125 levels are a sign that the cancer probably has spread beyond the uterus. If CA 125 levels are high before surgery, some doctors will track this number to find out how well the treatment is working. The levels will go down after surgery if treatment is killing the cancer cells. CA 125 levels may also be watched to see if the cancer has come back after treatment is done.
Video: Endometrial Biopsy
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