Diagnosing uterine cancer

Wednesday 1 April, 2015

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On this page: Physical examination | Transvaginal ultrasound | Hysteroscopy and biopsyBlood and urine tests | Further testsStaging and grading | Prognosis | Which health professionals will I see? | Key points


Your doctor will confirm the diagnosis of uterine cancer with a number of tests. You may have some or all of the following tests.

Physical examination

The doctor will feel your abdomen to check for swelling. 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 an instrument that separates the walls of the vagina (a speculum). This is similar to a Pap test (see box below).

Transvaginal ultrasound

A transvaginal ultrasound uses soundwaves to create a picture of the inside of your uterus and ovaries. A device called a transducer is put on your abdomen, and another transducer is inserted into your vagina. A computer creates an image based on the echoes produced when soundwaves meet something dense, like an organ or tumour.

Using the ultrasound, the doctor can see the size of your ovaries and uterus and the thickness of the endometrium. If anything appears unusual, the doctor may suggest you have a biopsy.

A Pap test (also called Pap smear or smear test) is used to check the cells inside the vagina and cervix. If these cells show changes, further tests may be needed. Occasionally, uterine cancer cells are detected in a Pap test, but this is uncommon.

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.

A telescope-like device called a hysteroscope is inserted through your vagina into your uterus, and some tissue is removed (biopsy) and sent to a laboratory 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 a 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.

Further tests

If the initial tests show you have uterine cancer, you will have scans to see if the cancer has spread. These tests are usually done at a hospital or radiology clinic. Each scan can take about an hour, and most people can go home as soon as the scans are done. Most cancers of the uterus are found early and do not require further tests.

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. The test is painless but can be noisy. 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.

MRI scan

The MRI (magnetic resonance imaging) scan uses a powerful magnet linked to a computer to take pictures of areas inside the body. You will lie on a table that slides into a metal cylinder. The test is painless, but some people find lying in the cylinder noisy and confined. If you feel claustrophobic, let your doctor or nurse know, as they may be able to give you headphones. An MRI test for cancer of the uterus 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 only for particular types of uterine cancer, such as sarcoma. If you have a PET scan for any other type of uterine tumour, you will not be eligible for a Medicare rebate.

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 will show whether you have uterine cancer and whether it has spread to other parts of the body. This testing process is called staging and helps your doctors decide what treatment is best for you.

Grading describes how the cancer cells look compared to normal cells and helps determine how aggressive the cancer cells are.

The tables below show how endometrial cancers are staged and graded. Uterine sarcomas are staged differently.

Staging
Stage 1
The cancer is found only in the uterus.
Stage 2
The cancer has spread from the uterus to the cervix.
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 or to other parts of the body.

 

Grading
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 very abnormal. These cancers tend to be more aggressive than lower-grade cancers.

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), but it is not possible for any doctor to predict the exact course of the illness.

How will doctors assess my prognosis?

Test results, the type of cancer you have, the rate and depth of tumour growth, how well you respond to treatment, and other factors such as your age, fitness and medical history are all important factors in assessing your prognosis. In most cases, the earlier uterine cancer is diagnosed, the better your prognosis. 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), it will probably be harder to treat.

Which health professionals will I see?

Your 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 will discuss your test results and treatment options with you.

A gynaecological oncologist will perform surgery if you need it and discuss your treatment options after the operation. You will be cared for by a range of health professionals who specialise in different aspects of your treatment.

Health professional Role
gynaecological oncologist a specialist who treats women with cancers of the reproductive system (for example, uterine, ovarian, cervical, vulvar and vaginal cancers)
radiation oncologist
prescribes and coordinates radiotherapy treatment and advises about side effects
medical oncologist prescribes and coordinates the course of chemotherapy
radiologist reads and interprets diagnostic scans (for example, CT, MRI and PET scans)
nurse care coordinator
supports patients and families throughout treatment and liaises with other staff
nurses help administer drugs including chemotherapy, help treat any radiotherapyinduced reactions, and provide information and support throughout your treatment
dietitian can recommend 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
physiotherapist and occupational therapist
help you with any physical or practical problems associated with cancer and treatment

Key points

  • If your doctor suspects you have uterine cancer, you will need to have a number of tests.
  • Your doctor will feel your abdomen to check for swelling (physical examination). You may also have a vaginal or cervical examination using a speculum. This is similar to a Pap test.
  • You will probably also have a transvaginal ultrasound, which uses soundwaves to create a picture of the inside of your uterus and ovaries.
  • If anything looks unusual on the ultrasound, your doctor will usually recommend you have a hysteroscopy and biopsy. This allows your doctor to see inside your uterus and remove some tissue for the examination of cancer cells (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. The scans can usually be done at a hospital or radiology clinic.
  • 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.
  • A range of health professionals who specialise in different aspects of your treatment will work together to care for you.

Reviewed by: Dr Sam Saidi, Senior Staff Specialist, Department of Gynaecological Oncology, Chris O’Brien Lifehouse, NSW; Sharon Ellis, Consumer; Anne Finch, Accredited Practising Dietitian, Campaign Project Officer, Cancer Council WA; Harrison Hills, Accredited Practising Dietitian, Nutrition and Physical Activity Project Officer, Cancer Council WA; Suparna Karpe, Clinical Psychologist, Department of Gynaecological Oncology, Westmead Hospital, NSW; Dr Pearly Khaw, Consultant Radiation Oncologist, Peter MacCallum Cancer Centre, VIC; Rosalind Robertson, Senior Psychologist, Gynaecological Cancer Centre, The Royal Hospital for Women, NSW; Deb Roffe, 13 11 20 Consultant, Cancer Council SA, Gynaecological Cancer Research Nurse, QIMR Berghofer Medical Research Institute, SA; Kylie Tilbury, Acting Gynaecology, Brain and CNS Cancer Nurse Care Coordinator, The Canberra Hospital, ACT.

Updated: 01 Apr, 2015