If you are worried that you may have endometrial cancer, what tests should you do?

Author: Chen Yangping, Foshan First People's Hospital

Reviewer: Wang Gang, Chief Physician, Sichuan Provincial Maternal and Child Health Hospital

When it comes to female tumors, people may first think of breast cancer and cervical cancer. Although endometrial cancer is not as well known as the above two cancers, its incidence and mortality rates have increased year by year in recent years, and the age of onset is showing a trend of younger age.

The increase in mortality is related to the failure of patients to be diagnosed early. Therefore, early screening for endometrial cancer is crucial. So, what are the screening programs for endometrial cancer?

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1. Gynecological examination is essential

For every female outpatient, the first examination is a gynecological examination. There are two main types of gynecological examinations. Although simple, they can provide doctors with information for disease diagnosis and differential diagnosis.

1. Visual examination The doctor observes the shape and color of the female vulva, vagina and cervix, as well as the vaginal discharge. Through observation, the doctor can determine whether there are any abnormalities in the above parts. At the same time, if the patient has symptoms of vaginal bleeding, the doctor can also determine the characteristics and source of the vaginal bleeding and use it as a basis for diagnosis.

2. Palpation There are two methods. ① Bimanual examination: also known as vaginal abdominal examination, which is to insert two fingers into the vagina to touch, while using the hand to cooperate with the examination on the abdomen. ③ Triple examination: that is, rectal vaginal abdominal examination. Compared with bimanual examination, triple examination adds palpation of the rectum. The doctor puts two fingers of one hand into the vagina and rectum respectively, and uses the other hand to cooperate with the examination on the abdomen. Through palpation, the doctor can understand the texture, size, mobility, tenderness, etc. of the vulva, vagina, cervix and uterine body, and can also understand whether there are masses in the vaginal wall, inside the uterus and pelvic cavity, as well as the size, texture, mobility, tenderness, etc. of the masses.

Affected by subjective and objective factors such as experience, gynecological examinations are limited in their effectiveness in assessing uterine and pelvic lesions. In order to make up for the shortcomings of gynecological examinations, doctors will recommend patients to undergo necessary auxiliary examinations based on their condition and needs to help clarify the diagnosis.

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2. Get tested even if you don’t have symptoms

Generally speaking, if the results of the gynecological examination are normal, there is no need to continue with further examinations. However, since some patients with endometrial cancer do not have typical symptoms in the early stages, it is recommended that high-risk groups undergo further examinations.

So, which groups of people are at high risk of endometrial cancer?

1. Women over 45 years old , especially those in menopause, should pay more attention to any abnormalities in menstruation. If there are any, do not ignore them and seek medical attention as soon as possible.

2. Infertility Women who have never given birth are more likely to develop endometrial cancer than women with a history of childbearing due to the lack of protection from progesterone.

3. Family history of cancer, especially family history of endometrial cancer or intestinal cancer. Studies have found that endometrial cancer is related to genetic factors. Therefore, women with a family history of cancer should pay more attention to screening.

Although the above-mentioned high-risk groups do not show any symptoms, doctors will still recommend vaginal exfoliative cytology examination (commonly known as "cervical smear") and transvaginal color Doppler ultrasound (commonly known as "vaginal ultrasound") just in case.

The cervical smear test is to use a scraper or a small brush to take some exfoliated cells from the patient's cervix, and then observe whether the cell morphology is normal under a microscope. If the result is abnormal, further examination is required.

Transvaginal B-ultrasound is to put the B-ultrasound probe into the vagina for ultrasound diagnosis. It can help doctors understand the basic information of the uterus more accurately, as well as whether there are abnormal echoes in the uterine cavity, and can also provide a reference for further examination.

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3. People with symptoms should be checked

If the patient has abnormal vaginal bleeding, or if ultrasound examination shows an enlarged uterus, thickened endometrium, or uneven echoes in the uterine cavity, the doctor will recommend a diagnostic curettage.

Diagnostic curettage is to examine the tissue on the endometrium by pathology to determine whether there is any abnormality in the endometrium. However, if the location of the lesion is not clear, blindly performing curettage is likely to result in missed diagnosis or misdiagnosis. Therefore, it is best to choose curettage under hysteroscopy, which will give a more accurate diagnosis.

In some cases, the doctor may recommend the following examinations based on the patient's condition.

1. Blood CA125 test CA125 is a tumor marker that exists in inflammatory cells and tumor cells. Therefore, the level of CA125 in the blood is an important reference indicator for determining whether a tumor has occurred in a patient.

The level of CA125 in the blood of patients with early endometrial cancer is basically within the normal range. Only when endometrial cancer spreads outside the uterus will the level of CA125 in the blood become abnormal.

Therefore, blood CA125 testing is also used to assess the extent of spread of endometrial cancer in order to determine the next treatment plan.

2. Pelvic MRI and CT examinations Pelvic MRI can better observe whether there are lesions in the pelvis, bladder and ovaries, while CT uses X-rays and detectors to perform cross-sectional scans of the patient's pelvis. Compared with MRI, CT may not only produce artifacts, but also be exposed to ionizing radiation, but the cost of MRI examinations is higher. Therefore, patients can reasonably undergo relevant examinations under the advice of doctors.