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Endometrial Cancer Investigations: Tests for Diagnosis

If a woman is suspected to have endometrial cancer, some investigations are required to confirm the diagnosis of the disease. Further, these investigations can help in determining the stage of disease, which in turn help in choosing an appropriate treatment option.

Following are some commonly used diagnostic tools for endometrial cancer:

  1. Transvaginal Ultrasound (TVUS): In this technique, a special vaginal probe is used, which direct very high-frequency sound waves towards the internal body parts to be examined. The sound waves are reflected off the internal structures depending upon their ability to reflect these waves and collected by a special detector to produce a real-time image of the internal tissues on a computer screen.

    This helps the doctor to examine the endometrium, fallopian tubes, ovaries, and other nearby structures for any abnormality. This test can detect any solid tumors (appear as a solid mass) or abnormal endometrial thickening that may indicate endometrial cancer. This test can also provide information regarding the location, extent of disease or invasion into the muscle layer (myometrium).

  2. Hysteroscopy: In this technique, a tiny telescope-like device is inserted into the uterus through vagina and cervix to closely examine the endometrium. This enables a doctor to determine any abnormal area(s) and to collect biopsy samples from such area(s) observed during the test.

  3. Endometrial Biopsy: Biopsy sample(s) from the endometrium is generally collected in case an abnormal area(s) is observed during the TVUS or hysteroscopy procedure. This can be removing a small amount of endometrial tissue via a thin tube inserted into the uterus through the cervix.

    In case the collected biopsy sample is inadequate or patient is being considered for a fertility-sparing treatment, a dilation and curettage (D&C) can be performed. In D&C, the cervix is dilated and endometrial tissue is scraped from inside of the uterus using special instruments.

    The collected biopsy sample is then tested in a laboratory for the presence of any abnormal/cancerous cells.

    It is recommended to collect and analyze biopsy sample to confirm the diagnosis of endometrial cancer. The biopsy sample can provide very useful information about the cancer cells such as the type of cancer, the severity of cancerous changes involved (grade of cancer), and the presence of specific defective genes or proteins.

  4. Imaging Tests: These tests are generally employed after the establishment of the pathological diagnosis. They help to detect the spread of disease to distant body parts and assess the stage of the disease so that an appropriate treatment option can be selected. Alternatively, these tests are employed after treatment to evaluate the treatment efficacy and to detect disease response, progression, or recurrence.

    Computed tomography (CT) scan: In this technique, detailed cross-sectional images of body organs are generated using x-rays, with or without a contrast medium. It can help diagnose the spread of disease to nearby/distant lymph nodes and other organs, and may also be used to guide a biopsy needle into the affected area.

    Positron emission tomography (PET) scan: This technique uses a radioactive substance (e.g.fluorodeoxyglucose [FDG]) that is given intravenously prior to the procedure. Cancer cells absorb larger amounts of the radioactive substance than normal cells.

    The areas of higher radioactivity indicate cancerous tissue on the PET scan. Thus, this technique can diagnose the spread of disease to distant body parts. It is usually combined with CT scan (PET/CT) .

    Magnetic resonance imaging (MRI) scan: This technique provides detailed images of tissues inside the body using radio waves, a strong magnetic field, and gadolinium contrast. It can accurately diagnose the extent of invasion and spread of disease to nearby/distant body parts.

    Chest X-ray: This is relatively less-sensitive imaging technique that can reveal the spread of cancer to lungs or pleura. Spread to lungs or pleura may appear as nodul(s), pleural effusion, etc.

  5. Blood tests for tumor marker: Tumor markers are generally proteins or other substances that are produced by both normal cells and cancer cells. However, in the case of cancer, the level of these markers rises in blood, urine, or other biological fluids, which can be detected by certain laboratory tests. Level of cancer antigen (CA)-125 has been reported to be elevated in many patients with endometrial cancer.

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