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 and Pap 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.

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 – You will lie on an examination table while the sonographer moves a small handheld device called a transducer over your abdomen.
• Transvaginal 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 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 just a few 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.

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

This type of biopsy is taken during a hysteroscopy, which allows the specialist to see inside your uterus and examine the lining for abnormalities. It will usually be done under a general anaesthetic as day surgery in hospital. The doctor inserts a thin tube with a tiny light and camera (known as a hysteroscope) through your vagina into the uterus.

To take the biopsy, the doctor uses surgical instruments to gently widen (dilate) the cervix and then remove some tissue from the uterine lining. 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 uterine cancer it is.

Further tests

After uterine cancer is diagnosed, 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:

• X-rays – You may have a chest x-ray to check your lungs and heart.
• CT scan – You will usually have a CT (computerised tomography) scan of your chest, abdomen and pelvis.
• MRI scan – This scan uses a powerful magnet and radio waves to create detailed cross-sectional pictures of the inside of your body.
• PET scan – You will be injected with a small amount of a glucose (sugar) solution, to allow cancer cells to show up brighter on the scan. PET scans are not routine tests for endometrial cancers, but may be recommended in particular cases.
  
  

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.

• 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 under a microscope compared to normal cells and estimates how fast the cancer is likely to grow.

• 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.

Prognosis

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 uterine cancer.

To work out your prognosis, your doctor will consider 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.

In general, the earlier cancer of the uterus is diagnosed, the better the outcome. 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.