Diagnosing uterine cancer

Wednesday 1 March, 2017

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On this page: Physical examination (pelvic examination) | Pelvic ultrasound | Hysteroscopy and biopsyBlood and urine tests | Further imaging testsStaging and grading uterine cancer | Prognosis | Which health professionals will I see? | Key points


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 Pap test is not used to diagnose uterine cancer.

Physical examination (pelvic 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.

Pelvic 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 ultrasound

To 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 ultrasound

If 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.

The dye used in a CT scan can cause allergies in some people. If you have had an allergic reaction to iodine or dyes during a previous scan tell the medical team beforehand.

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.)

The radiation that's absorbed into your body during a PET scan is generally not harmful and will leave your body within a few hours. Talk to your doctor before the scan if you are concerned.

Staging and grading uterine cancer

The tests described above help show whether you have uterine cancer and whether it has spread to other parts of the body. This testing process is called staging and it helps your health care team recommend the best treatment for you.

It is often not possible to work out the stage of uterine cancer until after the examination of any tissue removed during surgery.

Grading describes how the cancer cells look compared to normal cells and helps work out how aggressive the cancer cells may be. This is determined by a pathologist who looks at the biopsy sample under a microscope.

The tables below show how endometrial cancers are staged and graded. Uterine sarcomas are staged differently – to find out more talk to your specialist.

Prognosis

Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis and treatment options with any of your oncologists (gynaecological, radiation or medical). However, it is not possible for any doctor to predict the exact course of the disease in an individual person. Instead, your doctor can give you an idea about the general prognosis for people with the same type and stage of cancer. You will also have tests throughout your treatment that show how well the treatment is working.

Staging endometrial cancers
Stage 1
The cancer is found only in the uterus. Early or localised cancer
Stage 2
The cancer has spread from the uterus to the cervix. Regionalised cancer
Stage 3 The cancer has spread beyond the uterus/cervix to the ovaries, fallopian tubes, vagina or nearby lymph nodes.
Stage 4
The cancer has spread further, to the inside of the bladder or rectum, throughout the abdomen, to other parts of the body such as the bones or lung, or to distant lymph nodes. Metastatic or advanced cancer

 

Grading endometrial cancers
Grade 1 (low-grade) The cancer cells look slightly abnormal.
Grade 2 (moderate-grade)
The cancer cells look moderately abnormal.
Grade 3 (high-grade)
The cancer cells look more abnormal. These cancers tend to be more aggressive than lower-grade cancers.

As for most types of cancer, the results of treatment for uterine cancer tend to be better when the cancer is found and treated early. Most endometrial cancers, especially type 1 (endometrioid), have a good prognosis with high survival rates. If cancer is found after it has spread to other parts of the body (referred to as an advanced stage), the prognosis is worse and there is a higher chance of recurrence.

Test results, the type of uterine cancer, the rate and depth of tumour growth, the likelihood of response to treatment, and factors such as your age, level of fitness, and medical history are important in assessing your prognosis. These factors will also help your doctor advise you on the best treatment options.

Which health professionals will I see?

Your general practitioner (GP) or gynaecologist will arrange the first tests to assess your symptoms. If you do have uterine cancer you will be referred to a gynaecological oncologist who specialises in treating women with uterine cancer.

The gynaecological oncologist will discuss your test results and treatment options with you, and perform surgery if you need it.

You will be cared for by a range of health professionals who specialise in different aspects of your treatment. This is often referred to as a multidisciplinary team (see table below).

Health professional Role
gynaecological oncologist* specialises in treating women with cancers of the reproductive system (for example, uterine, ovarian, cervical, vulvar and vaginal cancers)
radiation oncologist*
prescribes and coordinates the course of radiotherapy and advises about side effects
medical oncologist* prescribes and coordinates the course of chemotherapy/hormonal therapy/clinical trials of experimental therapies
radiologist* reads and interprets diagnostic scans (for example, CT, MRI and PET scans)
cancer care coordinator
supports patients and families throughout treatment and liaises with other staff
oncology nurse administers drugs including chemotherapy, help treats any radiotherapy-induced reactions, and provides care, information and support throughout treatment
dietitian recommends an eating plan to help you manage nutrition-related symptoms and help you stay well during treatment and recovery
social worker and clinical psychologist
link you to support services and help you with any emotional problems associated with cancer and treatment, including financial concerns, insurance and superannuation claims
women's health physiotherapist
treats physical problems associated with treatment for gynaecological cancers, such as bladder and bowel issues, sexual issues and pelvic pain

* specialist doctor

Key points

  • If your doctor suspects you have uterine cancer, you will need to have several tests.
  • Your doctor will feel your abdomen to check for swelling or masses (pelvic examination). You may also have a vaginal or cervical examination using a speculum.
  • You will usually have a pelvic ultrasound, which uses soundwaves to create a picture of the inside of your uterus and ovaries. The sonographer may pass a small device called a transducer over the abdomen or insert it into the vagina.
  • If anything looks unusual on the ultrasound, you will normally have a hysteroscopy and biopsy. This allows your doctor to see inside your uterus and remove some tissue for examination (biopsy).
  • Blood and urine samples enable your doctor to assess your general health and help determine what treatment is best for you.
  • Further tests, including x-rays and CT, MRI and PET scans, may be required to check whether the cancer has spread from the uterus.
  • A stage and grade will be assigned to the cancer to describe how far it has spread and how fast the cancer cells are growing.
  • Prognosis means the expected outcome of a disease. If uterine cancer is diagnosed early, it can usually be treated successfully.
  • You will be treated by a gynaecological oncologist and other health professionals who will work together in a multidisciplinary team.

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.

Updated: 01 Mar, 2017