How womb cancer (endometrial cancer) is diagnosed

Your GP may do an internal vaginal examination and press down on your tummy at the same time to feel for anything unusual in your pelvis. This is sometimes called an internal pelvic examination.

You might have a blood test and you may be asked to give a sample of your urine for testing.

Your GP might arrange other tests or refer you directly to a doctor, called a gynaecologist, who specialises in treating conditions of a woman’s reproductive system. 

You will usually be referred urgently (within two weeks) if you have:

• vaginal bleeding after the menopause
• a lump in the pelvis that your GP can feel
• ongoing vaginal bleeding in between your periods after
• a normal pelvic examination.

At the hospital

At the hospital, your specialist will ask about your general health, any other medical problems you have, and whether you have any close relatives with womb or bowel cancer. You may also be introduced to a gynaecology nurse specialist, who will be able to give you information and support. The gynaecologist will examine you and carry out an internal pelvic examination.

You may also have a smear test taken if you haven’t had one recently. After this, they’ll explain the tests you need to have.

It’s likely you’ll have some blood taken for testing, and some of the following tests will be arranged:

Blood tests

Samples of your blood will be taken to check your general health, the number of blood cells in your blood (blood count), and to see how well your kidneys are working.

Trans-vaginal ultrasound

This uses sound waves to make up a picture of the inside of your womb. It tells your specialist how thick the lining of your womb| is. A small probe with a rounded end is placed gently in your vagina. The test can be a little uncomfortable but shouldn’t be painful. It only takes a few minutes. If it isn’t possible to do the scan through the vagina, it can be done by passing a small device over the tummy (abdomen).

Biopsy

This involves taking a sample of cells or tissue from the womb lining. The sample is examined under a microscope by an expert doctor (a pathologist) and checked for cancer cells. If there are cancer cells present, the biopsy results will also usually identify the type of womb cancer it is. Biopsies can be carried out in a number of ways:

Aspiration biopsy

You can have this done at your clinic appointment and you won’t usually need any anaesthetic.

But some women may need to have it done another time using a local or general anaesthetic.

Your doctor or nurse will gently put an instrument called a speculum into your vagina to keep it open. They carefully pass a fine tube (called a pipelle) through the cervix| into your womb. Then, using gentle suction, they draw some cells from the womb lining into the tube. This might cause you to feel some period-like cramps while it’s being done, but this usually wears off in a few minutes. After the test, you may have light bleeding and some mild period-like discomfort for a couple of days.

Hysteroscopy

This test uses a narrow tube that allows your doctor to examine the lining of your womb. You can have it done as an outpatient.

Your doctor will put a speculum into your vagina, and may inject a little anaesthetic into the cervix to make the test less uncomfortable. You may be advised to take some painkillers an hour before the test. After a few minutes, the doctor will carefully pass a very thin flexible tube (hysteroscope) with a light on the end through the vagina and cervix into your womb. Pictures of the inside of your womb will show up on a screen. Some clear fluid or air is put into the hysteroscope to allow the doctor to get a better picture. Your doctor can then take samples of tissue (biopsies) from the womb lining using the hysteroscope.

After the test, you’ll have some vaginal bleeding for a couple of days and some period-like cramps, which you can take mild painkillers for.

Hysteroscopy dilatation and curettage (D&C)

This small operation is done under a general anaesthetic. It’s usually done along with a hysteroscopy (see above) so the surgeon can examine the womb. The surgeon stretches (dilates) the cervix during the operation to open it, and uses a small instrument called a curette to carefully scrape some tissue from the womb lining. Afterwards you’ll probably have period-like pains and some vaginal bleeding for a couple of days.