The Sampling of Endometrial Tissue

To find out whether cancer is present or if the abnormal bleeding is due to some other benign process, such as hyperplasia, some of the endometrial tissue must be removed and examined under a microscope. Tissue can be sampled using an endometrial biopsy, dilation and curettage (D & C) or hysteroscopy.

Endometrial biopsy is an office procedure. The sample of endometrial tissue is obtained by the physician through a very thin suction tube inserted into the uterus, through the cervix. The tube removes a small amount of tissue. The discomfort this causes is similar to that of menstrual cramps.

Dilation and curettage (D & C) is an out-patient hospital procedure. It is used if an inadequate amount of tissue was taken from the biopsy or if a clear diagnosis of cancer cannot be made from the biopsy. The cervix is dilated and a special surgical instrument is used to scrape tissue from inside the uterus. The procedure takes about an hour and requires either a local or general anesthetic. Most women experience little discomfort. This procedure may or may not involve a hysteroscopy.

Hysteroscopy is a procedure that can be performed in a doctor’s office. A doctor uses a tiny telescope with a light on the end to examine the inside of a woman’s uterus. If any abnormalities are found, your doctor will take a biopsy sample. Patients receive a local anesthetic and may experience period-like pain for about a day afterwards.

The Testing of Endometrial Tissue

To determine whether cancer is present, a pathologist examines the tissue samples, removed by biopsy, D & C or hysteroscopy, under the microscope. If cancer is found, it is characterized and graded.

Occasionally, other tests are done before surgical treatment, such as a CA-125 blood test or imaging tests, to determine whether the cancer has spread; however, these tests are not usually done because they are rarely helpful.

The lab report will state whether it is an endometrioid cancer or any of the other types of endometrial cancer. (See Medical Description for details.)