Diagnosis

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The primary symptom of uterine cancer is abnormal vaginal bleeding, especially after menopause. Bleeding may be so light that it's only a pink discharge or drainage from the vagina.

Although irregular menstrual periods are common as you get closer to menopause, when hormone levels rise and fall unpredictably, they can also be a symptom of uterine abnormalities or uterine cancer. If your periods stop for several months and then start again with heavy bleeding, discuss your symptoms with your health care professional and ask for an examination. Also, be sure to mention any menstrual irregularities during regular checkups.

If you are postmenopausal, any vaginal bleeding is abnormal and you should contact your health care professional immediately. The earlier uterine cancer is diagnosed, the better the prognosis.

Whether you are pre- or postmenopausal, the absence of visible blood with any unusual vaginal discharge doesn't mean you don't have uterine cancer. If you experience any abnormal discharge, discuss it with your health care professional.

Also, if you have a family history or have been diagnosed with hereditary nonpolyposis colon cancer (HNPCC), you should be screened for uterine cancer every year beginning at age 35.

Diagnostic tests for uterine cancer include:

• Endometrial biopsy. During this procedure, your doctor inserts a small instrument through your vagina and cervix and uses suction to take a small tissue sample of the uterine lining. The procedure is performed in the doctor's office and, while uncomfortable, is not significantly painful. You may have cramps or pain for a short time after the procedure and your doctor will usually recommend taking Tylenol or other over-the-counter pain relievers before and after the procedure.
• Hysteroscopy. A hysteroscopy allows your health care professional to look inside your uterus. It is usually performed if the endometrial biopsy is inconclusive. During a hysteroscopy, a tiny telescope is inserted into the uterus through the cervix. The uterus is expanded with saline, allowing the doctor to view any abnormalities.
• Dilation and curettage (D&C). If your endometrial biopsy is not conclusive (i.e., if not enough tissue was retrieved), your health care professional may recommend a D&C to remove pieces of the lining of the uterus. During a D&C, the opening of the cervix is dilated and the walls of the uterus are gently scraped to remove any growths. The tissue is then checked for cancer cells. The procedure is typically performed on an outpatient basis, and takes about an hour. It may require general anesthesia or conscious sedation (medication that makes you drowsy, but still awake).

Other tests may include routine blood tests, a urine test and a chest x-ray. If the biopsy or D&C are positive, further evaluation and treatment will be required to remove the cancer and properly assess the extent of disease. In some cases, you may have an ultrasound, a CT scan or other scans before surgery.

Early diagnosis and treatment of uterine cancer is critical. This type of gynecologic cancer often can be successfully treated in its early stages. Before beginning any treatment, however, you may want to consult with a gynecologic oncologist, a physician who specializes in treating cancers of the reproductive tract. These doctors have the most experience in diagnosing and treating such conditions.

Staging Endometrial Cancer

After a diagnosis, your health care professional will "stage" the disease to determine if the disease has spread. The stage of the cancer provides information about treatment options and survival rates.

• Stage I: Cancer is found only in the main part of the uterus. It has not spread to the lymph nodes or distant sites.
• Stage II: Cancer cells have spread to the cervix, but not to the lymph nodes or distant sites.
• Stage III: Cancer cells have spread outside the uterus, such as the lymph nodes, spread to the fallopian tubes or ovaries.
• Stage IV: Cancer cells have spread beyond the pelvis, to other body parts, into the lining of the bladder or rectum and/or have spread to lymph nodes in the groin. Stage IV endometrial cancer may also have spread to organs farther away from the uterus, such as the lungs or bones.
• Recurrent: Recurrent disease means the cancer has come back (recurred) after it has been treated.