Making the Diagnosis
There's no screening test for endometrial cancer. It's true that these tumors are sometimes detected by the cervical Pap smear (see cervical cancer), but this screening test is hit-and-miss when it comes to endometrial cancer; it merely catches endometrial cells that have been dislodged and swept down to the cervix.
The only reliable diagnostic test for endometrial cancer is a tissue biopsy (sample). Tissue sampling from the endometrium, usually performed in the physician's office, is the surest diagnostic procedure. Another method of tissue sampling is a D&C (dilation of the cervix and curettage - cutting - of the uterine lining). However, a D&C requires anesthetic, and may be unsuitable for a woman who is very elderly or frail. A transvaginal ultrasound is another procedure that may help diagnose this cancer, but the results are less certain than a biopsy.
The vast majority of uterine cancers are detected early when a woman notices abnormal vaginal bleeding and consults her doctor. Abnormal bleeding should never be ignored, especially in a postmenopausal woman. Taking estrogen supplements occasionally causes harmless abnormal uterine bleeding, but a doctor should always be consulted in any case.
A D&C obviously isn't appropriate for random or routine screening, but some high-risk women might want to consider getting the test done every year. Women at high risk would include those taking strong estrogen supplements that aren't balanced with progesterone, obese women, and above all women taking certain doses of tamoxifen, the breast cancer medication, which increases the risk of endometrial cancer by a factor of five to twelve.