What tests might your gynecologic oncologist perform to determine treatment?
Most endometrial cancer cases are diagnosed by taking a biopsy of the uterine lining. If this has not already been done by your primary doctor, it will most likely be done in the office. The procedure involves passing a very narrow suction catheter (like a thin straw) through the cervix into the uterus. It does not require anesthesia. The main side effect of a uterine biopsy is brief cramping (lasting minutes to hours). This may be minimized by taking an over-the-counter pain medication prior to your biopsy. Some women, however, cannot tolerate a biopsy in the office and need to have a surgical procedure called a dilation and curettage (D&C) performed in conjunction with a hysteroscopy, which involves the use of a small camera that allows the surgeon to see inside the uterine cavity.
The uterine tissue taken during a biopsy is sent to a pathologist to be examined under a microscope to determine whether cancer is present. The pathologist can also determine the cancer grade and cell types, which are preliminary indicators of how aggressively the cancer may behave. The biopsy alone cannot determine what stage the cancer is. Your doctor may want to get your slides reviewed by a pathologist at his or her institution to confirm the diagnosis before surgery or any other treatment.
Sometimes endometrial cancer is suspected based on an abnormal ultrasound or MRI finding, but a biopsy must be performed to confirm the diagnosis. Ultrasound may be performed to determine the size of the uterus to see if it can be removed safely with minimally invasive surgery. An MRI may be done in women who might be candidates for fertility-sparing non-surgical management. A chest X-ray is routinely done to look for spread of the cancer to the lungs. A CT or PET scan might be ordered in certain situations but not routinely.