How does my doctor know I have endometrial (uterine) cancer?

If you’re having symptoms that might be caused by cancer in the uterus, your doctor will want to check further. Your doctor is likely to ask you questions about these things.

• Your health history
• Your reproductive history, such as when you had your first period, how many times you’ve been pregnant, and whether you have gone through menopause
• Your family history of cancer
• Lifestyle habits, such as what you eat

In addition, your doctor may also do a physical exam. Here are some tests your doctor or a specialized nurse may do to check you.

• Pelvic Exam - Your doctor places an instrument called a speculum into your vagina to hold it open. It may feel a little uncomfortable, but it doesn’t hurt. With the vagina open in this way, the doctor can see the top part of your vagina and your cervix. Then your doctor will insert a gloved finger or 2 into your vagina and use the other hand to press on your abdomen. This lets him or her feel your uterus, ovaries, bladder, rectum, and vagina to check for lumps or anything else unusual.
• Pap Test - Your doctor can do this test at the same time as the pelvic exam. While your vagina is held open with the speculum, your doctor inserts a small wooden spatula or brush to scrape a sample of cells from the cervix and upper vagina. The doctor sends these cells to a lab to be looked at under a microscope to check for cancer. The Pap test does not check cells from inside the uterus. So it doesn’t help diagnose uterine sarcoma. But it can help your doctor find out if your symptoms might be caused by something other than uterine sarcoma.
• Endometrial Biopsy - A biopsy is one way to find out if you have uterine sarcoma. This is done in a procedure that is similar to getting a Pap smear. It is usually done in your doctor’s office. In most cases, you will not need anesthesia. In some cases, your doctor may suggest a local anesthetic. If you need general anesthesia so that you will be asleep, then the biopsy is done in a hospital or an outpatient surgery center. You put your feet in stirrups. Your doctor uses a tool called a speculum to hold your vagina open. Then he or she inserts a thin tube through your vagina and cervix into your uterus to get a bit of tissue. The tissue is looked at under a microscope and checked for cancer. You may have spotting or bleeding for several days afterward.
• Dilation & Curettage (D&C) - A D&C is another kind of biopsy. It is usually done in the hospital or surgical center. Here’s how the procedure is done. You may get an anesthetic so that you are asleep and don’t feel pain. Or you may just be numbed in that area. Your vagina is held open with a tool called a speculum. Then, your cervix is opened wider (dilated) to allow instruments into the uterus. Your doctor inserts a small instrument through your vagina and cervix into your uterus. This tool lets him or her scrape away the endometrium, which is the lining of the uterus. You may notice cramps and bleeding after a D&C. A pathologist looks at the cells under a microscope to see if there is any cancer.

What Your Doctor Learns From These Tests

Your doctor makes decisions about your diagnosis based on the results of these tests. Your doctor may decide any of the following.

• You probably don’t have cancer.
• You need more tests to decide whether or not you have cancer. One type of uterine sarcoma, for example, often does not show up in a biopsy.
• You don’t have cancer, but you have changes inside your uterus that might turn into cancer in the future.
• You have cancer.

You may need other tests to find out the type of uterine cancer you have--uterine sarcoma or endometrial cancer.

Tests That Help Evaluate Uterine Cancer

Before your diagnosis, your doctor took a biopsy from your uterus to help find out if you had uterine cancer. It’s likely that your doctor has suggested that you have your uterus removed. If so, samples taken from your uterus after it is removed help your doctor decide whether you need more treatment.

In addition, your doctor may request tests to learn more about your type of uterine cancer, its location, and whether it has spread. Here are some of the tests you may have. You’ll likely have these same tests whether you have endometrial cancer or uterine sarcoma, though what the doctor looks for may be different.

• Transvaginal Ultrasound - High-frequency sound waves bounce off internal body parts to create an image of your pelvic area. These images help your doctor see if there are growths in the lining of your uterus. They also help your doctor measure the thickness of the lining. Here’s how it’s done. You must have a full bladder for this test. You may be asked to drink several glasses of water. Then, you lie on your back on a table. Your doctor inserts a thin, long probe into your vagina. It’s covered with a condom and lubricated. The doctor moves the probe around, and sound waves echo off the organs. A computer creates an image of your pelvic area based on these echoes. You may feel some pressure or mild discomfort. If your uterus has not yet been removed, your doctor may use a catheter to put saline into the uterus. The helps create a clearer image. The images help your doctor see if there are tumors.
• Cystoscopy - This test checks to see if cancer has spread to your urethra or bladder. Here’s how it’s done. You have this done in a hospital or an outpatient surgery center. You may be given a local anesthetic to numb the area. Or you may be given a general anesthesia so that you fall asleep and don’t feel anything. You lie flat on your back. Your doctor uses a thin tube with a light, called a cystoscope. The cystoscope may also have a camera in it. He or she inserts the tube up through your urethra and into your bladder. Water is also inserted through the cystoscope. You may feel uncomfortable. And you may feel a strong need to urinate. If needed, the doctor can take a tissue sample to check for cancer. The whole test takes between 5 and 20 minutes. You will need a ride home after the test. You may feel a burning sensation when you urinate for a few days after the test.
• Magnetic Resonance Imaging (MRI) - MRIs are used to find if cancer has spread outside of your uterus. MRIs may also help doctors decide whether or not a tumor is cancerous. MRIs use radio waves and magnets to create images of your body. For this test, you lie still on a table as it passes through a tubelike scanner. Then the scanner rotates around you. As it moves, it directs a continuous beam of magnetic waves at the area being examined. A computer uses the data from the magnetic waves to create a three-dimensional picture of the inside of your body. You may need more than one set of images. Each one may take 2 to 15 minutes, so the whole scan may take an hour or more. This test is painless and noninvasive. Ask for earplugs if they aren’t offered, since there is a loud thumping noise during the scan. If you’re claustrophobic, you may be given a sedative before having this test.
• CT Scan - A CT scan can help determine if cancer has come back or if it has spread to other organs. During a CT scan, X-rays scan the pelvis in about 15 to 25 seconds. These special X-rays are 100 times more sensitive than a typical X-ray. To have the test, you lie still on a table as it gradually slides through the center of the CT scanner. Then the scanner rotates around you, directing beams of X-rays at your pelvis. A computer uses the data from the X-rays to create many pictures of your pelvis, which can be used together to create a three-dimensional picture. A CT scan is painless and noninvasive. You may be asked to hold your breath one or more times during the scan. In some cases, you may be asked to drink a contrast dye 4 to 6 hours before the scan. And you may be asked not to eat anything in the time between drinking the contrast dye and the scan. The contrast dye will gradually pass through your system and exit through your bowel movements.

Other Tests

• A chest X-ray can show if the cancer has spread to your lungs. It may also be done before surgery to be sure you have no heart or lung problems. The procedure is quick and painless. An intravenous pyelogram (IVP) is an X-ray of your urinary tract, including your bladder, ureters, and kidneys. First, you’re injected with iodine, which acts as a contrast dye. Then, X-rays are taken over timed intervals to show the flow through the urinary tract. The test may take up to an hour. This shows if cancer has spread to that area.
• Positron Emission Tomography (PET) - PET can show where cancerous cells occur throughout the body. A special glucose dye injected into your vein helps highlight these cells. Researchers are studying whether PET can help determine which tumors are cancerous and which are not.
• Blood Tests - Blood tests may be done several times throughout your diagnosis and treatment. Some blood tests help your doctor decide if you’re healthy enough for surgery. Other blood tests help your doctor learn if cancer has spread or if treatment is working.