How is cancer of the uterus diagnosed?

The doctor will feel your abdomen (belly) to check for swelling and any masses. To check your uterus, they will place two fingers inside your vagina while pressing on your abdomen with their other hand. You may also have a vaginal or cervical examination using a speculum, an instrument that separates the walls of the vagina. This is the same instrument used when you have a cervical screening test. You can ask for a family member, friend or nurse to be present during the examination.

A pelvic ultrasound uses soundwaves to create a picture of the uterus and ovaries. The soundwaves echo when they meet something dense, like an organ or tumour, then a computer creates a picture from these echoes. A technician called a sonographer performs the scan. It can be done in two ways, and often you have both types at the same appointment.

Abdominal ultrasound – To get good pictures of the uterus and ovaries during an abdominal ultrasound, the bladder needs to be full, so you will be asked to drink water before the appointment. You will lie on an examination table while the sonographer moves a small handheld device called a transducer over your abdomen.

Transvaginal ultrasound – You don’t need a full bladder for this procedure. The sonographer inserts a transducer wand into your vagina. It will be covered with a disposable plastic sheath and gel to make it easier to insert. You may find a transvaginal ultrasound uncomfortable, but it should not  be painful.

If you feel embarrassed or concerned about having a transvaginal ultrasound, talk to the sonographer beforehand. You can ask for a  female sonographer or to have someone in the room with you (e.g. your partner, a friend or relative) if that makes you feel more comfortable.

If you have had an abdominal ultrasound, you will usually also need a transvaginal ultrasound as it provides a clearer picture of the uterus.

A pelvic ultrasound appointment usually takes 15–30 minutes. The pictures can show if any masses (tumours) are present in the uterus. If anything appears unusual, your doctor will suggest you have a biopsy.

This type of biopsy can be done in the specialist’s office and takes just a few minutes. A long, thin plastic tube called a pipelle is inserted into your vagina and through the cervix to gently suck cells from the lining of the uterus. This may cause some discomfort similar to period cramps. Your doctor may advise you to take some pain-relieving medicine before the procedure to reduce this discomfort.

The sample of cells will be sent to a specialist doctor called a pathologist for examination under a microscope. If the results of an endometrial biopsy are unclear, you may need another type of biopsy taken during a hysteroscopy.

This type of biopsy is taken during a hysteroscopy, which allows the specialist to see inside your uterus and examine the lining for abnormalities. It will usually be done under a general anaesthetic as day surgery in hospital.

The doctor inserts a thin tube with a tiny light and camera (known as a hysteroscope) through your vagina into the uterus. To take the biopsy, the doctor uses surgical instruments to gently widen (dilate) the cervix and then remove some tissue from the uterine lining. This is known as a dilation and curettage (D&C). You will stay in hospital for a few hours and are likely to have period-like cramps and light bleeding for a few days afterwards.

The tissue sample will be sent to a laboratory, and a specialist doctor called a pathologist will look at the cells under a microscope. The pathologist will be able to confirm whether or not the cells are cancerous, and which type of uterine cancer it is.

After uterine cancer is diagnosed, you may have blood tests to check your general health. Your doctor may also arrange one or more of the imaging tests below to see if the cancer has spread outside the uterus.

X-rays – You may have a chest x-ray to check your lungs and heart.

CT scan – You will usually have a CT (computerised tomography) scan of your chest, abdomen and pelvis. A CT uses x-rays and a computer to create a detailed picture of the inside of the body. However, it is not able to detect very small (less than 1 cm) tumours.

You will be asked not to eat or drink anything (fast) before the scan. You may need to have an injection of or drink a special dye. This dye is called contrast and it makes your organs appear white in the pictures so anything unusual can be seen more clearly. You will lie on a table that moves in and out of the scanner, which is large and round like a doughnut. The test is painless and takes about 15 minutes.

MRI scan – MRI (magnetic resonance imaging) is not covered by Medicare for uterine cancer, so check with your doctor what you will have to pay. This scan uses a powerful magnet and radio waves to create detailed cross-sectional pictures of the inside of your body.

If you are having an MRI scan, let your medical team know if you have a pacemaker or any other metallic object in your body. The magnet can interfere with some pacemakers, but newer pacemakers are often MRI‑compatible. You will usually be asked to fast for four hours before the scan. As with a CT scan, a dye may be injected into a vein to help make the pictures clearer.

For the scan, you will lie on a treatment table and it will slide into a large metal tube that is open at both ends. The test is painless, but the noisy, narrow machine makes some people feel anxious or claustrophobic. If you think you may become distressed, mention it beforehand to the medical team. You may be given medicine to help you relax, and you will usually be offered headphones or earplugs. This test can take between 30 and 90 minutes.

PET scan – Medicare covers the cost of PET (positron emission tomography) scans only for uterine sarcomas. PET scans are not routine tests for endometrial cancers, but may be recommended in particular cases – ask your doctor what you will have to pay.

Before a PET scan, you will be injected with a small amount of a glucose (sugar) solution containing some radioactive material. You will rest for 30–60 minutes while the solution spreads throughout your body, then you will have the scan. Cancer cells show up brighter on the scan because they absorb more of the glucose solution than normal cells do.

It may take a few hours to prepare for a PET scan, but the scan itself usually takes only about 15–30 minutes. The radioactive material in the glucose solution is not harmful and will leave your body within a few hours.

Before having scans, tell the doctor if you have any allergies or have had a reaction to contrast during previous scans. You should also let them know if you have diabetes or kidney disease or if you are pregnant or breastfeeding. 

Uterine cancer is usually removed surgically and the removed tissue is sent to a laboratory for further testing. For endometrial cancer, some of these tests will check whether the cancer cells have features that indicate a genetic cause for the cancer. Knowing whether the tumour has one of these features may help your treatment team decide on suitable treatment options.

For example, a small number of endometrial cancers are caused by Lynch syndrome. This syndrome is characterised by a fault in the genes that helps  the cell’s DNA repair itself (called mismatch repair or MMR genes). If you have Lynch syndrome, you are at increased risk of developing other cancers and it is important for you, your family and your doctors to know about this.