Screening for endometrial cancer (endometrial biopsy, transvaginal ultrasound, CA125) has never proven to be effective in asymptomatic women. There is a role for endometrial biopsy to gauge response to therapy for women who are using progestins as fertility-sparing or conservative management for endometrial hyperplasia/cancer. Women on tamoxifen have an increased risk of endometrial cancer. However, screening asymptomatic women on tamoxifen is not recommended. Only those who develop abnormal uterine bleeding need endometrial sampling.
Patients with endometrioid ovarian cancers and adult granulosa cell tumors of ovary have an increased risk for endometrial cancer, and hysterectomy is recommended routinely as part of their management. If fertility preservation is important, this should be discussed with the gynecologic oncologists at BC Cancer.
It must be emphasized that Pap smear is not a satisfactory screening procedure for endometrial cancer (it is only a screening test for cervical cancer). All cases of post-menopausal and intermenstrual bleeding or spotting require investigation, which includes a pelvic examination and endometrial tissue sampling. Post-menopausal women who develop a sudden onset of an unusual vaginal discharge in the absence of an identifiable vaginal cause may have endometrial cancer and require similar investigation. A variety of techniques are available to evaluate patients including endometrial biopsies, hysteroscopy and D&C. Pelvic ultrasound may be helpful to determine if there is a thickened endometrium, which may suggest endometrial pathology (polyp, cancer). However, a biopsy is still required to obtain a tissue diagnosis.
NB: A normal endometrial thickness on ultrasound does not rule out endometrial cancer.