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Cancer of the uterus

Diagnosing cancer of the uterus


Your doctor will usually start with a physical examination and ultrasound of the pelvic area, but a diagnosis of uterine cancer can only be made by removing a tissue sample for checking (biopsy). Cervical screening tests (formerly called Pap smears or tests) are not used to diagnose uterine cancer.

Pelvic examination

The doctor will feel your abdomen (belly) 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. You may also have a vaginal or cervical examination using a speculum, an instrument that separates the walls of the vagina. You can ask for a family member, friend or nurse to be present during the examination.

Pelvic ultrasound

A pelvic ultrasound uses soundwaves to create a picture of the uterus and ovaries. The soundwaves echo when they meet something dense, like an organ or tumour, then a computer creates a picture from these echoes. It can be done in two ways, and often you have both types at the same appointment:

  • Abdominal ultrasound – The bladder needs to be full to get a clear picture of the uterus, 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 abdomen.
  • Transvaginal ultrasound – You don't need a full bladder for this type of ultrasound. The sonographer inserts a transducer wand into your vagina. It will be covered with a disposable plastic sheath and gel to make it easier to insert. You may find a transvaginal ultrasound uncomfortable, but it should not be painful. 

If you feel embarrassed or concerned about having a transvaginal ultrasound, talk to the sonographer beforehand. You can ask for a female sonographer or to have someone in the room with you (e.g. your partner, a friend or relative) if that makes you feel more comfortable.

If you have had an abdominal ultrasound, you will usually also need a transvaginal ultrasound as it provides a clearer picture of the uterus. A pelvic ultrasound appointment usually takes 15–30 minutes. The pictures can show if any masses (tumours) are present in the uterus. If anything appears unusual, your doctor will suggest you have a biopsy.

Endometrial biopsy

This type of biopsy can be done in the specialist’s office and takes about 10-15 minutes. A long, thin plastic tube called a pipelle is inserted into your vagina and through the cervix to gently suck cells from the lining of the uterus. This may cause some discomfort similar to period cramps. Your doctor may advise you to take some pain medicine before the procedure to reduce this discomfort.

The sample of cells will be sent to a specialist doctor called a pathologist for examination under a microscope. If the results of an endometrial biopsy are unclear, you may need another type of biopsy taken during a hysteroscopy.

Hysteroscopy and biopsy

A hysteroscopy allows the specialist to see inside your uterus, examine the lining for abnormalities and take tissue samples (biopsy). It will usually be done under a general anaesthetic as day surgery in hospital.

The doctor will look inside the uterus by inserting a thin tube with a tiny light and camera (known as a hysteroscope) through your vagina into the uterine cavity. Your cervix will also be gently widened (dilated) and some tissue will be removed from the uterine lining (called a dilation and curettage or D&C).

You will stay in hospital for a few hours and are likely to have period-like cramps and light bleeding for a few days afterwards. From the tissue sample, the pathologist will be able to confirm whether or not the cells are cancerous, and which type of cancer of the uterus it is.

Further tests

After diagnosis, you may have blood tests to check your general health. Your doctor may also arrange one or more of the imaging tests below to see if the cancer has spread outside the uterus:

  • CT (computerised tomography) scan
  • MRI (magnetic resonance imaging) scan
  • PET-CT scan (combines positron emission tomography with a CT scan)

Check with your doctor or medical imaging provider if, and how much, you will have to pay for these tests. Before having scans, tell the doctor if you have any allergies or have had a reaction to contrast dyes during previous scans. You should also let them know if you have diabetes or kidney disease or if you are pregnant or breastfeeding. 

Genetic tests after surgery

Cancer of the uterus is often removed surgically and the removed tissue is sent to a laboratory for further testing to find out more about the type and features of the cancer. For endometrial cancer, the tissue sample may be checked for inherited gene changes.

For example, a small number of endometrial cancers are caused by Lynch syndrome. This syndrome is linked to an inherited fault in the genes that helps the cell’s DNA repair itself (called deficient mismatch repair or dMMR genes). If you have Lynch syndrome, you are at increased risk of developing other cancers and it is important for you, your family and your doctors to know about this. 

Also, knowing if the tumour contains a faulty gene will help your treatment team decide if further treatment may be needed after surgery.

Staging and grading

Knowing the stage and grade of the cancer helps your doctors recommend the best treatment for your situation. Uterine sarcomas are staged differently, so discuss this with your specialist.

Staging is a way to describe the size of the cancer and whether it has spread to other parts of the body. The four stages of endometrial cancers may be divided into sub-stages, such as A. B and C, which indicate increasing amounts of tumour.

  • Stage 1 (early or localised) – The cancer is found only in the uterus.
  • Stage 2 (regionalised) – The cancer has spread from the uterus to the cervix. 
  • Stage 3 (regionalised) – The cancer has spread beyond the uterus/cervix to the ovaries, fallopian tubes, vagina, or lymph nodes in the pelvis or abdomen.
  • Stage 4 (metastatic or advanced) – The cancer has spread further, to the bladder, bowel or rectum, throughout the abdomen, to other parts of the body such as the bones or lung, or to lymph nodes in the groin. 

Grading describes how the cancer cells look compared to normal cells and estimates how fast the cancer is likely to grow.

  • Grade 1 (low grade) – The cancer cells look slightly abnormal and are slow growing.
  • Grade 2 (moderate grade) – The cancer cells look moderately abnormal and are growing at a moderate rate.
  • Grade 3 (high grade) – The cancer cells look more abnormal and tend to be faster growing than lower-grade cancers.


Prognosis means the expected outcome of a disease. While it is not possible to predict the exact course of the disease, your doctor can give you an idea about the general outlook for people with the same type and stage of cancer of the uterus.

To work out your prognosis, your doctor will consider test results, the type of cancer of the uterus, 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.

In general, the earlier cancer of the uterus is diagnosed, the better the prognosis. Most early-stage endometrial cancers have a good prognosis with high survival rates. If cancer is found after it has spread to other parts of the body (advanced cancer), the prognosis is not as good and there is a higher chance of the cancer coming back after treatment or continuing to grow.

Understanding Cancer of the Uterus

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Expert content reviewers:

A/Prof Orla McNally, Consultant Gynaecological Oncologist, Director Oncology/Dysplasia, Royal Women’s Hospital, Honorary Clinical Associate Professor, University of Melbourne, and Director of Gynaecology Tumour Stream, Victorian Comprehensive Cancer Centre, VIC; A/Prof Yoland Antill, Medical Oncologist, Peninsula Health, Parkville Familial Cancer Centre, Cabrini Health and Monash University, VIC; Grace Guerzoni, Consumer; Zeina Hayes, 13 11 20 Consultant, Cancer Council Victoria; Bronwyn Jennings, Gynaecology Oncology Clinical Nurse Consultant, Mater Hospital Brisbane, QLD; A/Prof Christopher Milross, Director of Mission and Radiation Oncologist, Chris O’Brien Lifehouse, NSW; Mariad O’Gorman, Clinical Psychologist, Liverpool Cancer Therapy Centre and Bankstown Cancer Centre, NSW

Page last updated:

The information on this webpage was adapted from Understanding Cancer of the Uterus - A guide for people with cancer, their families and friends (2023 edition). This webpage was last updated in November 2023. 

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