Diagnosis of uterine cancer

Diagnosing uterine cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and will do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for uterine cancer or other health problems.

The process of diagnosis may seem long and frustrating. It’s normal to worry, but try to remember that other health conditions can cause similar symptoms as uterine cancer. It’s important for the healthcare team to rule out other reasons for a health problem first before making a diagnosis of uterine cancer.

The following tests are commonly used to rule out or diagnose uterine cancer. Many of the same tests used to diagnose cancer are used to find out the stage, which is how far the cancer has progressed. Your doctor may also order other tests to check your general health and to help plan your treatment.

Your health history is a record of your symptoms, risk factors and all the medical events and problems you have had in the past. In taking a health history, your doctor will ask questions about a personal history of:

• symptoms that might suggest uterine cancer
• hormone replacement therapy use
• menstruation
• pregnancy
• prior use of tamoxifen (Nolvadex, Tamofen) in the treatment or prevention of breast cancer
• endometrial hyperplasia
• polycystic ovarian syndrome or ovarian tumours
• previous radiation therapy to the pelvis
• being overweight or obese
• diabetes
• hypertension

Your doctor may also ask about a family history of:

• uterine, ovarian, breast or colon cancers
• other inherited cancer syndrome

A physical exam allows your doctor to look for any signs of uterine cancer. During a physical exam, your doctor may:

• check your weight and blood pressure
• listen to your chest
• do a pelvic and rectal exam
• feel the abdomen for an enlarged liver, any lumps, or fluid build up in the abdomen (called ascites)
• feel for swollen lymph nodes in the groin and above the collarbone

Find out more about physical exam and pelvic exam.

A CBC measures the number and quality of white blood cells, red blood cells and platelets. A CBC is done to check for anemia from vaginal bleeding. A CBC also gives doctors a baseline to compare future blood tests to during and after treatment.

Find out more about complete blood count (CBC)..

An ultrasound uses high-frequency sound waves to make images of structures in the body. For transvaginal ultrasound, the sound waves are made by a small ultrasound probe that is gently inserted just inside the vagina.

Transvaginal ultrasound can be used to:

• find out the thickness of the endometrium
• see if there are any masses in the uterus
• check if the cancer is growing into the muscle layer of the uterus wall (called the myometrium)
• check if the cancer has spread to other areas of the pelvis

Find out more about ultrasound.

During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a pathology lab. The report from the lab will confirm whether or not cancer cells are present in the sample.

Endometrial biopsy removes small pieces of the inner lining of the uterus (called the endometrium). It is usually done in the doctor’s office. A type of endoscopy called a hysteroscopy may be done at the same time.

Dilation and curettage (D&C) is a procedure in which the cervix (the lower, narrow part of the uterus, or womb) is widened (dilated) so that a curette (a spoon-shaped instrument with a sharp edge) can be inserted into the uterus to remove cells, tissues or growths from the endometrium. It may be done if the sample taken during an endometrial biopsy was too small to make a diagnosis or if the results are inconclusive or show endometrial hyperplasia. This is done in the operating room.

Find out more about biopsy.

Endoscopy allows a doctor to look inside a body cavity using a flexible or rigid tube with a light and lens on the end. This tool is called an endoscope.

Hysteroscopy is commonly done if you have abnormal vaginal bleeding. It can help doctors find and diagnose abnormal changes inside the uterus. Tissue samples can be taken for biopsy to find out if the changes are non-cancerous, precancerous or cancerous.

Cystoscopy may be done if you have problems urinating or notice blood in your urine. Doctors use it to find out if cancer has spread to the bladder and urethra.

Proctoscopy may be done if you have changes to your bowel movements. Doctors use it to find out if cancer has spread to the rectum.

Find out more about endoscopy and cystoscopy.

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are functioning and can help find abnormalities. Blood chemistry tests used to stage uterine cancer include the following.

Blood urea nitrogen (BUN) and creatinine may be measured to check kidney function. Higher than normal levels could mean 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. Higher than normal levels could mean that cancer has spread to the liver.

Find out more about blood chemistry tests.

Tumour markers are substances found in the blood, tissues or fluids removed from the body. An abnormal amount of a tumour marker may mean that a woman has uterine cancer.

Tumour marker tests are generally used to check your response to cancer treatment. They can also be used to diagnose uterine cancer.

Cancer antigen 125 (CA125) may be measured. A higher than normal level may mean that there is advanced or metastatic uterine cancer.

Find about more about tumour marker tests and cancer antigen 125 (CA125).

A barium enema is an imaging test that uses a contrast medium (barium sulphate) and x-rays to make pictures of the large intestine. It may be done to find out if cancer has spread to the rectum. A barium enema may be done in women who have symptoms that suggest the cancer may have spread to the rectum.

Find about more about barium enema.

An x-ray uses small doses of radiation to make an image of the body’s structures on film. It is used to see if uterine cancer has spread to the lungs.

Find out more about x-ray.

A computed tomography (CT) scan uses special x-ray equipment to make 3-D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.

A CT scan is used to find out if the cancer has spread to other organs or if it has come back after treatment.

Find out more about CT scan.

Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3-D pictures.

MRI is used to find out how far the cancer has grown into, or invaded, the muscle layer of uterus wall (called the myometrium). It may also help doctors determine if the cancer has spread to other organs or if it has come back after treatment.

Find out more about MRI.

To make the decisions that are right for you, ask your healthcare team questions about diagnosis.