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  • How is cancer of the uterus diagnosed?

    Contents

    Diagnosis

    If your doctor suspects you have uterine cancer, you may have some of the following tests, but you are unlikely to need all of them. The main tests for diagnosing cancer of the uterus are transvaginal ultrasound, examination of the lining of the uterus (hysteroscopy) and tissue sampling (biopsy). A Cervical Screening Test is not used to diagnose uterine cancer.

    Physical examination

    The doctor will feel your abdomen 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. This is called a bimanual examination. 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 Pap test.

    Ultrasound

    A pelvic ultrasound uses soundwaves to create a picture of your uterus and ovaries. A computer creates an image based on the echoes produced when soundwaves meet something dense, like an organ or tumour. A technician called a sonographer performs the scan. It can be done in two ways:

    Abdominal ultrasoundTo 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 abdominal area.

    Transvaginal ultrasoundIf you have had an abdominal ultrasound, you will be able to empty your bladder between procedures. The sonographer will insert a transducer wand into your vagina. The wand will be covered with a disposable plastic sheath and gel to make it easier to insert. Some women find the transvaginal ultrasound procedure uncomfortable, but it should not be painful. Talk to the sonographer before the ultrasound if you feel embarrassed or concerned. You can ask for a female sonographer or to have someone in the room with you (e.g. your partner or a female relative) if that makes you feel more comfortable.

    Many women will have both procedures. The transvaginal ultrasound is often the preferred type of ultrasound, as it provides a clearer picture of your uterus.

    The ultrasound pictures can show the size of your ovaries and uterus, any masses (tumours) present in the uterus, and the thickness of the endometrium. If anything appears unusual, your doctor may suggest you have a biopsy.

    Hysteroscopy and biopsy

    You may have a hysteroscopy and biopsy if your doctor suspects cancer is present. A hysteroscopy is a procedure that allows the gynaecologist or gynaecological oncologist to see inside your uterus and examine the lining for abnormalities.

    During a hysteroscopy, your doctor will insert a telescope-like device called a hysteroscope through your vagina into your uterus. Your doctor will remove some tissue from the uterine lining (biopsy) and send it to a tissue specialist (pathologist) for examination. The tissue sample can be taken in different ways:

    • Part of the uterine lining is lightly scraped out. This is called a dilation and curettage (D&C), and is the most common and accurate way to remove tissue for a biopsy.
       
    • A long, thin plastic tube (Pipelle) is used to gently suck cells from the womb. This is called an endometrial biopsy and is often performed in the doctor’s surgery.

    Some women may have an endometrial biopsy as an outpatient under a local anaesthetic. If you have a D&C, you may need a general anaesthetic and to stay in hospital for a few hours. These tests can cause you to have period-like cramps and light bleeding for a few days afterwards.

    Blood and urine tests

    You might have blood and urine tests to assess your general health. The test results can help you and your doctor to make treatment decisions. In some cases you might be asked to have a test for a marker in the blood called CA125 (a protein that can be produced by uterine cancer cells). If the level is abnormal, it might be used for monitoring later on during treatment or to decide on more imaging tests before surgery.

    Further imaging tests

    Most cancers of the uterus are found early and do not require further tests. If the initial tests show you have uterine cancer, you may have additional imaging to see if the cancer has spread. Each scan can take about an hour, and most people can go home as soon as the scans are done.

    X-rays
    You may have a chest x-ray to check that your lungs and heart are healthy. This will usually happen before surgery.

    CT scan
    A CT (computerised tomography) scan uses x-ray beams to take pictures of the inside of your body. It is used when the doctor suspects the cancer may have spread outside of the uterus.

    You will be asked not to eat or drink anything before the scan, except for a liquid dye. This makes your organs appear white in the pictures, so anything unusual can be seen more clearly. You may also receive a separate injection of dye, which makes blood vessels easier to see. The CT scan machine is large and round like a doughnut. You will lie on a table that moves in and out of the scanner. The test is painless but can be noisy.

    MRI scan
    The MRI (magnetic resonance imaging) scan uses a powerful magnet linked to a computer to take pictures of areas inside the body. It can be helpful to confirm if the cancer has spread from the uterus to the cervix or deeply invades the muscle of the uterus. You will lie on a treatment table that slides into a metal cylinder. The test is painless, but some people find lying in the cylinder noisy and confined. You will be given headphones to protect your hearing and to make you more comfortable. This test can take 40–45 minutes.

    PET scan
    During a PET (positron emission tomography) scan, you will be injected with a glucose (sugar) solution containing a small amount of radioactive material. The PET scan detects increased amounts of radioactive glucose in areas of the body where there are cancer cells, because these cells cannot eliminate this glucose in the way that normal cells do. PET scans are usually used for particular types of uterine cancer, such as sarcoma. They are sometimes also used to help with staging some cases of endometrial cancer. (However, Medicare only covers the cost for PET scans for uterine sarcomas.)

    This website page was last reviewed and updated July 2018.

    Information reviewed by: A/Prof Sam Saidi, Senior Staff Specialist, Gynaecological Oncology Group, Chris O’Brien Lifehouse, NSW; Lauren Atkins, Accredited Practising Dietitian, Peter MacCallum Cancer Centre, VIC; Dr Scott Carruthers, Radiation Oncologist, Royal Adelaide Hospital, SA; Prof Michael Friedlander, Medical Oncologist, Royal Hospital for Women Sydney, NSW; Roslyn McAullay, Social Worker, Women and Newborn Health Service, King Edward Memorial Hospital, WA; Anne Mellon, Clinical Nurse Consultant, Hunter New England Centre for Gynaecological Cancer, NSW; Christine O’Bryan, Consumer; Deb Roffe, 13 11 20 Consultant, Cancer Council SA; Department of Physiotherapy, King Edward Memorial Hospital for Women, WA.

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