An ultrasound combined with a sample of tissue from the inside of the uterus will generally identify the cause of postmenopausal vaginal bleeding. Years ago, a surgical dilatation and curettage was the only way to obtain tissue. Now, a quick office procedure is usually performed in which a thin flexible catheter is threaded through the cervical opening into the uterine cavity. The catheter has a suction device on it such that a tiny amount of tissue can be aspirated and sent to the lab for analysis. Most uterine samples yield reassuring results, but on occasion uterine cancer, the most common gynecologic malignancy and the fourth most common cancer to occur in women, is detected.