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There are no early detection tests or examinations for women who are at normal risk of developing endometrial cancer. If women exhibit signs and symptoms of the condition (e.g., abnormal spotting, bleeding or discharge; pelvic mass and/or pain and weight loss), testing is mandatory.

Pelvic exams are successful in finding some cancers of the female reproductive system. However, they are not very effective in detecting early endometrial cancers. Although a Pap test can occasionally identify some early endometrial cancers, most cancers are not diagnosed with this test. However, the Pap test has proven very effective in finding early cervical cancers. The American Cancer Society (ACS) recommends regular cervical cancer screenings for most women beginning at age 21 or approximately three years after they first engage in vaginal intercourse. Certain groups of women may not require a cervical cancer screening, such as those who have had a complete hysterectomy (surgical removal of the cervix and uterus) for reasons other than cervical precancer or cancer.

The ACS also recommends that all menopausal patients and those with increased risk of developing endometrial cancer be informed of their risk, and immediately notify their physician if they experience any irregular uterine bleeding. Annual testing, including endometrial biopsy, should be offered for women age 35 and older with a family history of hereditary nonpolyposis colon cancer (HNPCC), which is a risk factor for endometrial cancer. This includes:

• Patients known to carry gene mutations associated with HNPCC
  
  
• Patients who are likely to carry HNPCC-associated gene mutations
  
  
• Patients with a family history of colon cancer, who have not undergone genetic testing

Diagnosis of endometrial cancer typically begins with a complete medical history, physical examination and pelvic examination. If cancer is suspected, the patient may be referred to a gynecologic oncologist, a physician who specializes in treating female reproductive cancers. The following tests may also be performed:

• Endometrial tissue sampling. To determine the presence of cancer, the physician will remove a sample of endometrial tissue for examination under a microscope. The physician can obtain this tissue through an endometrial biopsy or by dilation and curettage (D & C). It may be performed either with or without a hysteroscopy, a test that allows the gynecologist to view the interior of the uterus through a thin, illuminated tube. Types of biopsy include:
  
  
• Endometrial biopsy. A procedure in which a thin, flexible tube is inserted through the cervix into the uterus, and suction is used to obtain a sample of endometrial tissue. This procedure, which takes about a minute, is typically performed in a medical office. Local anesthesia of the cervix may be used to numb the area. During and after the procedure, the patient may experience pain that resembles severe menstrual cramps, which can often be relieved with over-the-counter pain medication. Endometrial biopsy is the most common test for endometrial cancer.
  
  
• D & C. If an endometrial biopsy is inconclusive, or does not provide a sufficient amount of tissue, a D & C must be performed. This outpatient procedure may be accompanied by a hysteroscopy. During a D & C, the cervix is dilated and tissue is scraped from the inside of the uterus using a special surgical instrument. D & C takes approximately an hour, and may require sedation or general anesthesia. Most women experience little discomfort following this procedure but some may have cramping and abdominal pain.
  
  
A pathologist will examine the endometrial tissue under a microscope following these procedures to diagnose the presence of cancer. If cancer is detected, it will be characterized and then graded. The grade of the cancer is an estimation of how much of the cancer tissue no longer resembles endometrial tissue:



• Grade 1: Less than 5 percent of the tissue looks abnormal.
  
  
• Grade 2: Less than 50 percent of the tissue looks abnormal.
  
  
• Grade 3: More then 50 percent of the tissue looks abnormal.
  
  
Patients with lower-grade cancers have a lower likelihood of advanced cancer or recurrences and usually have a better prognosis (outlook for recovery).



• Imaging tests. Most patients do not require imaging tests before surgery. However, patients with cancer that appears to be advanced or recurrent may benefit from a transvaginal ultrasound (a test that creates images of the uterus using sound waves)  or other assessments. CAT scan is rarely used to diagnose endometrial cancer but may be used to determine if the cancer has spread to other tissues or organs. Magnetic resonance imaging (MRI) scans may be used to evaluate how far the cancer has spread into the uterus.
  
  
• Blood tests. The physician may also order tests to measure hormone levels or a complete blood count (CBC) to ensure that the patient can undergo surgery safely. In addition, the CA 125 blood test can identify substances released into the bloodstream by some endometrial cancers, but cannot be considered a reliable screening test. Very high levels of CA 125 may indicate that the cancer has spread beyond the uterus and may be used by physicians to help determine the need for surgery.
  
  
• Other tests. The physician may perform cystoscopy or proctoscopy (examination of the bladder or rectum, respectively, through an illuminated tube).