Diagnosis of uterine cancer

Diagnosis is the process of finding out the cause of a health problem. Diagnosing cancer often means first ruling out other health conditions that share similar symptoms with cancer. It can be a very worrying time for you and your loved ones. Sometimes this process is quick. Sometimes it can feel long and frustrating. But it’s important for doctors to get all the information they need before making a diagnosis of cancer.

Diagnosing uterine cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and 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 following tests are usually used to rule out or diagnose uterine cancer. Many of the tests that are used to diagnose cancer are also used to find out the stage (how far the cancer has spread). 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, risks and all the medical events and problems you have had in the past. Your doctor will ask questions about your history of:

• symptoms that suggest uterine cancer
• taking hormone replacement therapy
• menstruation
• pregnancy
• prior use of the hormone therapy drug tamoxifen in the treatment or prevention of breast cancer
• endometrial intraepithelial neoplasia
• polycystic ovary syndrome or ovarian tumours
• previous radiation therapy to the pelvis
• having overweight or obesity
• diabetes
• high blood pressure (called hypertension)

Your doctor may also ask about a family history of:

• uterine, ovarian, breast or colorectal cancers
• certain genetic conditions, such as Lynch syndrome

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

• measure 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 buildup (called ascites)
• feel for swollen lymph nodes in the groin and above the collarbone

Find out more about a physical exam and pelvic exam.

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 a low red blood cell count (called anemia) from bleeding from the vagina.

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

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

A transvaginal ultrasound can be used to:

• find out the thickness of the endometrium, which is the inner lining of the uterus
• see if there are any tumours 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 ultrasounds.

During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a lab. A report from a pathologist will show whether or not cancer cells are found in the sample.

An endometrial biopsy removes small pieces of the endometrium. It’s usually done in the doctor’s office. A hysteroscopy may be done at the same time.

Dilation and curettage (D&C) is a procedure in which the cervix 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 can 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 intraepithelial neoplasia, which is a precancerous condition of the uterus. It can be done instead of an endometrial biopsy if you wish to preserve your fertility. D&C is done in an operating room.

Find out more about biopsy.

Doctors use a combination of pathology tests and DNA sequencing tests to determine the molecular subtype of endometrial cancer cells. This information will help your healthcare team decide which treatments will work best for you.

Find out more about cell and tissue studies.

Estrogen and progesterone are hormones that can stimulate the growth of uterine cancer cells. Hormone receptor status tests look for estrogen receptors (ERs) and progesterone receptors (PRs) in the uterine cancer cells. This information will help your healthcare team decide which treatments will work best for you.

Find out more about hormone receptor status testing.

The HER2 gene is also known as the ERBB2 or HER2/neu gene. HER2 stands for human epidermal growth factor receptor 2. It's a gene that has changed (mutated). It's called an oncogene because it helps a tumour grow.

HER2 status testing is done to find out if uterine cancer cells are making more HER2 protein than normal (called overexpression). This information will help your healthcare team decide which treatments will work best for you.

Find out more about HER2 status testing.

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

Blood urea nitrogen (BUN) and creatinine may be measured to check how well the kidneys are working. 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 how well the liver is working. Increased levels could indicate 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 person has uterine cancer.

Tumour marker tests can be used to diagnose uterine cancer, but they are generally used to check how treatment is working, or your response to cancer treatment.

The level of cancer antigen 125 (CA125) may be higher if there is advanced or metastatic uterine cancer.

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

An x-ray uses small amounts of radiation to make an image of parts of the body on film. It's used to see if uterine cancer has spread to the lungs.

Find out more about x-rays.

A computed tomography (CT) scan uses special x-ray equipment to make 3D 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 may be done before surgery to find out if the cancer has spread to other organs or if it has come back after treatment.

Find out more about CT scans.

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 3D pictures.

An MRI may be done before surgery to find out how far the cancer has grown into the myometrium (the muscle layer of the uterine wall). It may also show if the cancer has spread to other organs or if it has come back after treatment.

Find out more about MRIs.

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

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

A cystoscopy may be done if you have problems urinating or you notice blood in the urine. It’s used to find out if cancer has spread to the bladder and urethra.

A proctoscopy may be done if you have changes to your bowel movements. It’s used to find out if cancer has spread to the rectum.

Find out more about endoscopy and cystoscopy.

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