Your doctor can start the diagnosis by asking you questions about your medical history and the symptoms you experience. The interrogation cannot confirm the disease, but give your doctor an idea. In addition, your physician can do a physical examination to examine your abdomen and pelvic area to look for signs that indicate endometrial cancer.
However, for women who are closed to menopause and have regular menstruation, the diagnosis is more difficult; there may be menorrhagia (heavier bleeding) or bleeding of a cause that has nothing to do with cancer. To rule out these non-cancerous bleeding, your doctor will do a pelvic examination with a small speculum to directly visualize the cervix. In the absence of cancer, these tests usually show a normal cervix.
However, a Pelvic exam is not enough to confirm the presence of a cancer in your endometrium; the following tests will be recommended:
Pap test – this test is done to look inside the vagina and the outside of the uterus. During the test, your physician can introduce a speculum into your vagina to take sample of cells from the cervix for a microscopic exam. A Pap test (Pap smear) may not reveal an endometrial cancer; it is, however, a key procedure to detect suspicious anomalies that can lead to cancer.
Transvaginal ultrasound – this is a painless medical technique consists of inserting two or three inches of the tip of a transducer in your vagina to visualize the reproductive organs: uterus, ovaries, cervix, and vagina. This test allows your doctor to obtain images of these organs from different angles, and possibibly detect the development of an endometrial cancer. Usually, if the test reveals any cancerous lesion, your physician will perform a biopsy to accurately confirm the disease.
Biopsy – although others methods may reveal an endometrial cancer, a biopsy is usually necessary to establish with certainty the diagnosis. During the procedure, your doctor removes a small piece of tissue from your endometrium for laboratory analysis. If cancer cells are found, other techniques will be performed to determine the speed of the cells to multiply.
Although rare, an endometrial biopsy may lead to complications such as infections, bleeding or uterine perforation. If you experience pain or bleeding after the biopsy, see your doctor immediately.
Dilation and curettage (D and C) – this medical technique allows your health care provider to evacuate or gradually open your cervix for analysis purpose. In general, dilation and curettage isperformed under local or general anesthesia; it is usually recommended in case, during the biopsy, enough tissue was not obtained. During the procedure, your doctor scrapes the lining of the uterus to collect tissue sample. The sample will then be examined under microscope to look for cancer cells.
Dilatation and curettage often causes pain similar to menstrual cramps one or two days after the surgery. If these problems persist for more than three days, see your doctor immediately; this may be a sign of complications.
Laparotomy – laparotomy is a surgical procedure that can be done during an endometrial cancer diagnosis to determine the severity of the tumor. During the surgery, your surgeon makes an incision in your abdomen to explore the abdomen organs. Performed under general anesthesia, a laparotomy allows your surgeon to visualize and evaluate the tumor, surrounding tissue and lymph nodes. Laparotomy can also allow your physician to measure the extent of the tumor and whether it has spread to other organs.
Hormone test – although rarely performed before the treatment, your doctor may recommend a hormone test to search for estrogen receptors; endometrial cancer cells grow better in a high-estrogen environment. A positive result indicates that hormone therapy can have a positive effect against the cancer.