If a woman is having abnormal vaginal bleeding or other symptoms, the evaluation starts with a detailed interview. A health care provider asks questions about the woman’s symptoms, her medical history and any current conditions, her family’s medical history, her menstrual and pregnancy history, and her habits and lifestyle. This information helps the health care provider determine the cause of the symptoms. The interview is followed by a physical examination, including a pelvic examination.
If a health care provider suspects uterine cancer, he or she refers the woman to a specialist in cancers of the female genital tract (gynecologic oncologist).
No blood or imaging studies can confirm the diagnosis of endometrial carcinoma. Lab tests may be performed after endometrial cancer is diagnosed to ensure that a woman is able to undergo treatment and also to monitor treatment progress.
- Tumor markers: A woman’s blood may be checked for a tumor marker known as CA 125. This marker is commonly elevated in patients with ovarian cancer; however, this marker is nonspecific for endometrial cancer. CA 125 is released into the bloodstream by some ovarian and uterine tumors. A very high level of CA 125 sometimes indicates that a cancer has spread from the endometrium to other parts of the body. If a woman’s blood has a high level of CA 125 at the time that her cancer is diagnosed, this marker will be checked periodically as a measure of how well the treatment is working. For example, after the uterus and tumor are surgically removed, the tumor marker level may decrease dramatically.
- Routine blood tests: Tests of blood chemistry, liver and kidney functions, and blood cell counts are done to check a woman’s overall health and her ability to tolerate surgery and other therapy. Imaging studies
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In many instances, imaging studies are not necessary but if performed may include the following:
- Vaginal (transvaginal) ultrasound: Ultrasound is a technique that uses sound waves to take a picture of the internal organs. Ultrasound is the same technique used to look at a fetus in the uterus. To perform a vaginal (transvaginal) ultrasound, a small device called a transducer is inserted into the vagina. The device emits sound waves, which bounce off the pelvic organs and transmit a picture to a video monitor. Often, the examiner moves the transducer around slightly to get a better picture. A vaginal (transvaginal) ultrasound is safe and painless.
- Hydroultrasound: Hydroultrasound is similar to vaginal (transvaginal) ultrasound, but a saline (salt water) solution is first injected into the uterus to extend the uterine walls. This procedure can improve the picture in some cases and show the uterus in greater detail.Ultrasound often can reveal a uterine tumor, but the findings are not always conclusive.
Other imaging tests may be needed and might include the following:
- A CT scan of the pelvis would be the usual choice of a follow-up imaging test. A CT scan is like an x-ray film but shows greater detail in 2 dimensions.
- An MRI of the pelvis is another choice of a follow-up imaging test. An MRI shows great detail in 3 dimensions.
- A chest x-ray may be needed if metastasis to the lungs is suspected.
- A bone scan may be needed if metastasis to the bones is suspected.
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