How Endometrial Cancer Is Diagnosed

While most women begin the process of being diagnosed with endometrial cancer as a result of visiting their healthcare provider for abnormal vaginal bleeding or discharge, for some women, the diagnostic process begins as a result of an abnormality detected during a routine pelvic examination.

Whatever starts the process, it's important to keep in mind that an endometrial biopsy (when a tissue sample is removed from the inner lining of the uterus) is the gold standard test for diagnosing endometrial cancer. That said, other tests like a thorough medical history and blood and imaging tests certainly aid in the diagnostic process.

endometrial cancer diagnosis
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Medical History

Let's say a woman comes in with abnormal vaginal bleeding. In order for a gynecologist (a healthcare provider who specializes in treating the female reproductive system) to pinpoint a diagnosis, including a possibility for endometrial cancer, she will start by asking several questions about the bleeding.

Some of these questions may include:

  • How long has the bleeding gone on for?
  • How much are you bleeding?
  • Are there any symptoms associated with the bleeding? (for example, pain, fever, or an odor)
  • Does the bleeding occur after sex?
  • What medications are you taking?
  • Do you have a family or personal history of bleeding problems?
  • Are you experiencing any new vaginal discharge, even if non-bloody?

This last question is pertinent because while the vast majority of endometrial cancers cause abnormal vaginal bleeding (if any symptoms are present), a non-bloody vaginal discharge may also be a sign.

After reviewing a woman's medical history, a gynecologist will perform a physical examination, including a pelvic exam, to confirm that the bleeding is coming from the uterus and not from other organs (for example, the vulva, cervix, anus, or rectum).

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Labs and Tests

In addition to a medical history and physical examination, various tests may be performed, mostly to rule out non-uterine problems. For instance, since the cervix connects the uterus to the vagina, a pap smear may be performed. During a pap smear, a cell sample is taken from the cervix to screen for cervical cancer. Likewise, if a woman is noting vaginal discharge or odor, a cervical swab may be performed to check for infection.

Blood Tests

There is no single blood test that can diagnose endometrial cancer. However, many healthcare providers will order a complete blood count (CBC) to check for anemia (low red blood cell count), which may be caused by endometrial cancer, among other health conditions. Other blood tests your healthcare provider may order to evaluate for whole-body causes of bleeding include:

  • Blood clotting tests
  • Thyroid function panel
  • Complete metabolic panel (CMP) to check for liver or kidney disease
  • Pregnancy test

Imaging and Biopsy

An ultrasound (a machine that uses sound waves to take images of the body) is the first test used to evaluate a woman's reproductive organs, including her uterus, ovaries, and fallopian tubes. Your healthcare provider may start with a pelvic ultrasound, in which the ultrasound probe is placed (along with warm gel) on the lower abdomen or pelvis. Then he will move forward with a transvaginal ultrasound, which is a more optimal test for visualizing the uterus and determining whether or not endometrial cancer is present.

Transvaginal Ultrasound

With a transvaginal ultrasound, the ultrasound probe is placed inside the vagina where it is closer to the uterus. During the transvaginal ultrasound, the lining of the uterus is examined and measured. In addition, certain endometrial abnormalities, like polyps or tumors, can be visualized

Saline Infusion Sonohysterography

A saline infusion sonohysterography entails a gynecologist performing a transvaginal ultrasound after filling the uterus with saline (salt water). Compared to a transvaginal ultrasound, this test allows for better visualization of the uterus, so smaller and more obscure abnormalities may be detected.

While an ultrasound is a helpful tool, the only way to diagnose endometrial cancer is through a biopsy.

Endometrial Biopsy and Hysteroscopy

An endometrial biopsy means that a small tissue sample of the uterus is removed by the gynecologist during a procedure called a hysteroscopy, which is a procedure usually performed in a healthcare provider's office using local anesthesia.

During a hysteroscopy, a tiny scope is placed into the uterus through the vagina and cervix. A small amount of tissue is then removed by a special suction instrument.

This tissue sample is then examined under a microscope by a specialized healthcare provider called a pathologist. The pathologist looks at the tissue to see whether there are cancerous cells present.

Sometimes, an endometrial biopsy is not sufficient, meaning not enough tissue was gathered, or the biopsy results are unclear (the pathologist can not definitively say whether cancer cells are present). In this case, a procedure called a dilation and curettage (D&C) will be performed.

Dilation and Curettage (D&C)

A D&C is a more complicated procedure that cannot be done in the healthcare provider's office, but rather in an outpatient surgical center, as it requires general anesthesia or sedation (in addition to local anesthesia or an epidural to numb the lower part of the body). During a D&C, the cervix is dilated, and a thin instrument (called a curette) is used to scrape away tissue from the inner lining of the uterus. A D&C can be done with or without the use of a hysteroscope.


Once endometrial cancer is diagnosed, a specialized cancer healthcare provider (called a gynecologic oncologist) will stage the cancer, which means she will determine if and how far the cancer has spread.

The tests used to stage endometrial cancer often include:

  • Chest X-ray
  • Computed tomography (CT) scan
  • Magnetic resonance imaging (MRI) test

Many women with endometrial cancer, especially those with more advanced disease, benefit from surgical staging, which involves surgery to comprehensively evaluate how far disease has spread in the body.

Stages of Endometrial Cancer

  • Stage 1: Cancer has not spread outside the body of the uterus
  • Stage 2: Cancer has spread from the body of the uterus into the cervical stroma (tissue that connects the uterus to the cervix)
  • Stage 3: Cancer has spread to the outer surface of the uterus or outside of the uterus to the pelvic lymph nodes, fallopian tubes, ovaries, or vagina
  • Stage 4: Cancer has spread to the rectum, bladder, groin lymph nodes, abdomen, or distant organs like the lungs, liver, or bones

Differential Diagnosis

It's important to understand there are many potential noncancerous conditions that can cause abnormal bleeding from the uterus; however, the only way to be certain that cancer is (or is not) present is through a biopsy, which is why a visit to your gynecologist is essential.

Other possible causes of abnormal uterine bleeding that your healthcare provider will consider, include:

  • Excessive thinning of the vaginal and uterine lining (due to low estrogen levels in menopause)
  • Uterine polyps or fibroids
  • Infection of the uterus
  • Medications like blood thinners

Of course, keep in mind that what you may think is vaginal bleeding may, in fact, be bleeding from a different location, such as your bladder or rectum. This is why a thorough medical history and physical examination is important to start—so only necessary tests (like an endometrial biopsy) are performed.

Premenopausal Women

While endometrial cancer is most common in postmenopausal women, it's important to note that it can occur in young women, even adolescents (albeit rarely). This is why in certain instances (for example if a woman is 45 years or older or has risk factors for endometrial cancer (regardless of her age), she will still need to be ruled out for cancer with an endometrial biopsy.

In terms of a differential diagnosis of abnormal uterine bleeding in premenopausal women, a healthcare provider will consider some of the following conditions: 

  • Polycystic ovarian syndrome or other problems related to ovulation
  • Pregnancy
  • Problems linked to birth control pills or an intrauterine device
  • Fibroids and polyps

Frequently Asked Questions

  • Can a Pap smear detect endometrial cancer?

    No. Very rarely, a sample of the tissue taken for a Pap smear to screen for cervical cancer may show signs of abnormalities in endometrial tissue. However, a Pap smear cannot detect or definitively diagnose endometrial cancer.

  • Who's most likely to get endometrial cancer?

    The primary risk factors include:

    • Taking certain medications, particularly tamoxifen and estrogen without progestin
    • Eating a high-fat diet
    • Being overweight or obese
    • Never giving birth
    • Early menstruation or late menopause
    • Having the gene for hereditary non-polyposis colon cancer (HNPCC)
  • Should I be screened for endometrial cancer?

    Only if you carry the gene for hereditary non-polyposis colon cancer (HNPCC) and you're 35 or older, in which case your healthcare provider may suggest you have yearly endometrial biopsies to screen for signs of cancer. Routine screening is not recommended for other women.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Cancer Society. Signs and Symptoms of Endometrial Cancer

  2. American Cancer Society. Tests for Endometrial Cancer

  3. US National Library of Medicine. Medline Plus. Abnormal uterine bleeding

  4. Gu M, Shi W, Barakat RR, et al. Pap smears in women with endometrial carcinomaActa Cytol. 2001;45(4):555-560. doi:10.1159/000327864

  5. National Cancer Institute. Endometrial cancer screening (PDQ)—Patient version.

  6. American Cancer Society. Can endometrial cancer be found early?

Additional Reading

By Colleen Doherty, MD
 Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis.