Diagnosis is the process of finding the underlying cause of a health problem. The process of diagnosis may seem long and frustrating, but it is important for the doctor to rule out other possible reasons for a health problem before making a cancer diagnosis. Diagnostic tests for uterine cancer are usually done when:
- the symptoms suggestive of uterine cancer are present
- the doctor suspects uterine cancer after talking with a woman about her health and completing a physical examination
Many of the same tests used to initially diagnose cancer are also used to determine the stage (how far the cancer has progressed). Your doctor may also order other tests to check your general health and to help plan your treatment. Tests may include the following.
Medical history and physical examination
The medical history is a record of all present symptoms, risk factors and all the medical events and problems a person has had in the past. A woman's family history may also help the doctor to diagnose uterine cancer.
In taking a medical history, the doctor will ask questions about:
- a personal history of
- estrogen replacement therapy used
- menstruation pattern
- childbearing
- use of tamoxifen (Nolvadex, Tamofen) in the treatment for breast cancer
- prior endometrial hyperplasia and treatment
- previous pelvic radiation therapy
- diabetes
- hypertension
- gallbladder disease
- inherited cancer syndromes
- a family (first-degree relative) history of
- uterine cancer
- inherited cancer syndromes
- signs and symptoms that may suggest uterine cancer
A physical examination allows the doctor to look for any signs of uterine cancer. During a physical examination, the doctor may:
- check for obesity and determine weight
- check the blood pressure
- listen to the chest
- do a pelvic examination
- feel the abdomen for an enlarged liver, an abdominal lump or fluid in the abdomen (ascites)
- feel for swollen lymph nodes in the groin and above the collarbone
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Complete blood count
A complete blood count (CBC) measures the number and quality of white blood cells, red blood cells and platelets. A CBC is done to:
- check for anemia due to long-term (chronic) bleeding from the vagina
- provide a baseline for comparing future blood counts taken during and after treatment
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Transvaginal ultrasound
Ultrasound uses high-frequency sound waves to make images of structures in the body. The sound waves are produced by a probe that is put inside the vagina. Transvaginal ultrasound can be used to:
- accurately determine the thickness of the endometrium
- A thickened endometrium may indicate uterine cancer.
- find abnormal masses in the uterus
- check for signs that show how far a tumour has spread in the pelvis
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Biopsy
During a biopsy, a small amount of tissues or cells are removed from the uterus so they can be tested in a laboratory. The pathology report from the laboratory will confirm whether or not cancer cells are present in the sample. The biopsy procedures that commonly are used to diagnose uterine cancer are:
- endometrial biopsy – a procedure that removes small samples of the endometrium (uterine lining)
- It is most often done in the doctor's office because there is no need for general anesthetic. A hysteroscopy may be done at the same time.
- This procedure is as accurate in detecting endometrial cancer as more invasive tests.
- dilation and curettage (D&C) – a procedure that scrapes tissue from the endometrium for biopsy
- D&C may be done if:
- The result of the endometrial biopsy is inconclusive or indicates endometrial hyperplasia.
- The sample from the endometrial biopsy was too small to make a definitive diagnosis.
- An endometrial biopsy cannot be taken in the doctor's office because the cervical opening is too narrow or the woman feels too much discomfort for an adequate sampling.
- It is commonly done in the operating room as an outpatient procedure in a hospital.
- A hysteroscopy may be done at the same time.
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Endoscopy
Endoscopy allows a doctor to look inside body cavities using a camera connected to a flexible tube with a light and lens on the end (an endoscope). Hysteroscopy can be helpful for diagnosing abnormal uterine bleeding.
Doctors do a hysteroscopy to:
- look for abnormal areas inside the uterus, which may be caused by benign, precancerous or cancerous changes
- determine the extent of the abnormality
- take tissue samples for biopsy
Doctors will also do the following endoscopic procedures when women have bowel or bladder symptoms that suggest the cancer may have spread:
- cystoscopy – to find out if cancer has spread to the bladder and urethra
- proctoscopy – to find out if cancer has spread to the rectum
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Blood chemistry tests
Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are functioning and can also be used to detect abnormalities. Some blood chemistry values may be higher than normal in metastatic uterine cancer.
- Urea (blood urea nitrogen or BUN) and creatinine may be measured to check kidney function. Increased levels could indicate that cancer has spread to the ureters or kidneys.
- Alanine aminotransferase (ALT), aspartate transaminase (AST) and alkaline phosphatase may be measured to check liver function. Increased levels could indicate that cancer has spread to the liver.
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Tumour marker tests
Tumour markers are substances – usually proteins – in the blood that may indicate the presence of uterine cancer. Tumour marker tests are used to check a woman's response to cancer treatment, but they can also be used to plan the treatment for uterine cancer.
The tumour marker that may be measured is cancer antigen 125 (CA125). An elevated level may indicate the presence of advanced or metastatic uterine cancer.
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Chest x-ray
An x-ray uses small doses of radiation to make images of the body’s structures on film. A chest x-ray may be done to see if uterine cancer has spread to the lungs.
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Barium enema
A barium enema may be done in women who have symptoms that suggest the cancer may have spread to the rectum.
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Computed tomography (CT) scan
A CT scan uses special x-ray equipment to make 3-dimensional and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures. CT scans may be helpful in determining if the cancer has spread to other organs or if it has come back after treatment.
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Magnetic resonance imaging (MRI)
MRI uses powerful magnetic forces and radio-frequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3-dimensional pictures. MRI may be helpful in determining how far the cancer has invaded into the myometrium (muscle layer of uterus). It may also be useful in determining if the cancer has spread to other organs or if it has come back after treatment.
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Surgery
Surgical staging is necessary to accurately determine the extent of uterine cancer. This means that the stage is based on examination of all tissues removed during an operation. The stage cannot be accurately determined until after surgery is done. The surgery is commonly done through an incision in the abdomen while the woman is under general anesthesia. In some cases, surgery can be done by laparoscopy using special equipment inserted through small incisions.
Surgical staging is commonly recommended as the first step in treatment for uterine cancer. Surgical staging can include:
- thorough pelvic and rectal examination
- total hysterectomy and bilateral salpingo-oophorectomy (removal of the uterus, cervix, both Fallopian tubes and both ovaries)
- These surgeries are done to determine how far the cancer has invaded into the myometrium (muscle layer of uterus), cervix, ovaries and Fallopian tubes.
- biopsy of tissue from suspicious areas inside the abdomen
- removal of lymph nodes in the pelvis and around the large artery in the abdomen (aorta) to see if cancer has spread to these areas
- taking a sample of the omentum (fat pad around the stomach)
During surgery for uterine cancer, the doctor may also rinse the pelvis and abdominal cavity with fluid. A sample of the fluid (peritoneal washings) will be examined to see if it contains cancer cells. Doctors use this information to help determine prognosis.
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See a list of questions to ask your doctor about diagnostic tests.