Uterine cancer detection and diagnosis

A thorough and accurate cancer diagnosis is critical to determining a uterine cancer patient’s treatment plan. At City of Hope, our multidisciplinary team of experts use a broad range of tests and tools designed for diagnosing uterine cancer. Cancer type, stage and overall health are considered when developing a treatment plan tailored to each patient’s needs and goals. Imaging and laboratory tests will be used to monitor the patient’s response to treatment, and our cancer experts will modify the care plan when needed.

The two primary types of uterine cancer are:

• Endometrial cancer is the more common type of cancer affecting the uterus. Cancer cells develop in the endometrium, the lining of the uterus.
• Uterine sarcoma is both rare and difficult to treat because of its aggressive nature. It occurs when cancer cells develop in the muscles of the uterus or tissues that support it.

Endometrial cancer detection and diagnosis

For those experiencing symptoms of endometrial cancer, doctors may recommend a physical and pelvic examination. The main tests to detect endometrial cancer fall into two categories—ultrasound and endometrial tissue sampling.

Ultrasound uses sound waves to create images of the organs in the reproductive system and may be done externally or internally:

• For a pelvic ultrasound, the doctor moves a transducer, which resembles a small wand, over the skin of the lower abdomen. Preparation may include drinking water, because a full bladder helps create better images.
• For a transvaginal ultrasound, which provides a more detailed view of the uterus, the doctor inserts a probe through the vagina to capture images of the uterus. This test helps spot a tumor in the uterus, a thicker endometrium and any abnormalities in the myometrium, the layer of the uterus that’s made of muscle.

Endometrial tissue sampling involves removing a small amount of tissue from the endometrium and may be done with one of the following procedures:

Endometrial biopsy is the most common endometrial cancer test. The doctor places a thin, flexible tube through the cervix into the uterus and uses suction to remove a small piece of the endometrium. The suctioning procedure typically takes a minute or less. The doctor may prescribe a nonsteroidal anti-inflammatory drug (NSAIDs) such as ibuprofen ahead of time or give an injection of local anesthetic to numb the area before the procedure.

Dilation & curettage (D&C) with hysteroscopy involves dilating (or increasing the opening of) the cervix and using a spoon-shaped tool called a curette to remove a uterine tissue sample. Anesthesia may be given before a D&C to minimize discomfort.

• Hysteroscopy involves filling the uterus with saline (salt water) solution, then placing a thin telescope through the cervix and into the uterus so the doctor may examine its lining and take tissue samples if needed. Local anesthesia may be provided for this procedure.

Doctors may also recommend blood tests to help diagnose or stage endometrial cancer, including:

Advanced genomic testing is the most common lab test for uterine cancer. The analysis examines a tumor for DNA alterations that are driving the growth of cancer. By identifying the mutations that occur in a cancer cell's genome, we may better understand the tumor behavior, and we may be able to tailor a treatment based on these findings.

CA-125 test measures the amount of the CA-125 protein in the blood. High amounts of CA-125 may indicate uterine, ovarian, fallopian tube or peritoneal cancer, as well as less serious conditions such as endometriosis or abdominal inflammation. We often use this test in combination with other diagnostic methods. A CA-125 test is also used during cancer treatment. High levels of CA-125 that begin to decline may indicate that the treatment is having a positive effect. If the level instead continues to rise, the doctor may consider changing the treatment regimen.

Uterine sarcoma detection and diagnosis

Uterine sarcomas are often found during or following a surgical procedure to address what appeared to be benign fibroid tumors. In some cases, they may be diagnosed because of a patient’s symptoms.

Many of the same methods used to detect and diagnose endometrial cancer are also utilized for detecting uterine sarcoma, including:

• Physical and pelvic exams
• Discussion about symptoms and medical history
• Endometrial tissue sampling
• Transvaginal ultrasound

Other kinds of tests may be needed to determine whether uterine sarcoma has spread beyond the uterus. These include:

• Cystoscopy uses a lighted tube, or scope, to determine whether the cancer has reached the bladder.
• Proctoscopy, which also uses a lighted tube, helps determine whether the cancer has reached the rectum.
• Computed tomography (CT) scan is a specialized X-ray machine that takes pictures of multiple areas of the body. It may be helpful in determining whether the cancer has spread elsewhere in the body.
• Magnetic resonance imaging (MRI) uses radio waves and strong magnets to take detailed pictures of the inside of the body and see how deep into the uterus the cancer has grown.
• CT/PET (positron emission tomography) scan starts with injecting radioactive glucose, or sugar, into a vein. The radioactive glucose collects within cancer cells if they’re present, and a scanner identifies them.
• Chest X-ray: This may help determine whether cancer cells have reached the lungs.

How you can prepare

If your doctor schedules uterine cancer testing, it’s important to follow all preparation steps. These may include arranging for someone to drive home afterward. Be aware of any guidelines to follow once home, such as getting rest and monitoring for side effects. Make sure you know what to watch for and when to call your care team.