Suspected Endometrial Cancer A Pap smear of the ectocervix and endocervix should be completed. The uterus, adnexa, cervix, vagina, and rectum should be palpated by bimanual rectovaginal exam for masses, nodularity, induration, and immobility. Endometrial sampling with a Pipelle aspirator is indicated in postmenopausal women with vaginal bleeding or perimenopausal women with a menstrual abnormality. Suspicious lesions are biopsied. A stool occult blood test is completed.
Endocervical curettage is necessary because endocervical carcinoma can missed by endometrial biopsy.
If the endometrial biopsy has been performed and no significant abnormality was detected, no further evaluation is needed. Hysteroscopy may also be helpful to evaluate the endometrium further.