Uterine Cancer: Diagnosis

Approved by the Cancer.Net Editorial Board, 04/2016

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. To see other pages, use the menu.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know whether an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

This list describes options for diagnosing this type of cancer, and not all tests listed will be used for every woman. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected
  • Your signs and symptoms
  • Your age and medical condition
  • The results of earlier medical tests

In addition to a physical examination, the following imaging tests may be used to diagnose uterine cancer:

  • Pelvic examination. The doctor feels the uterus, vagina, ovaries, and rectum to check for any unusual findings. A Pap test, often done with a pelvic examination, is primarily done to evaluate for cervical cancer.  However, sometimes a Pap test may occasionally find abnormal glandular cells, which are caused by uterine cancer.

  • Transvaginal ultrasound. An ultrasound uses sound waves to create a picture of internal organs. In a transvaginal ultrasound, an ultrasound wand is inserted into the vagina and aimed at the uterus to obtain the pictures. If the endometrium looks too thick, the doctor may decide to perform a biopsy (see below).

  • Computed tomography (CT or CAT) scan. A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a liquid to drink. 

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein. This is particularly useful to get detailed images if the treatment option is primarily hormone management (see Treatment Options). MRI is often used when fertility conservation is considered.

Doctors also use the following surgical tests to establish a diagnosis:

  • Endometrial biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. A pathologist then analyzes the sample(s).  A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

    For an endometrial biopsy, the doctor removes a small sample of tissue with a very thin tube. The tube is inserted into the uterus through the cervix, and the tissue is removed with suction. This process takes about 1 minute. Afterward, the woman may have cramps and vaginal bleeding. These symptoms should go away soon after and can be reduced by taking a nonsteroidal anti-inflammatory drug (NSAID) as directed by the doctor. Endometrial biopsy is often a very accurate way to diagnose uterine cancer. However, patients who have abnormal vaginal bleeding before the test may still need a dilation & curettage (D&C; see below) even if no abnormal cells are found during the biopsy.

  • Dilatation and Curetage (D&C). A D&C is a procedure to remove tissue samples from the uterus. A woman is given anesthesia during the procedure to block the awareness of pain. A D&C is often done in combination with a hysteroscopy so the doctor can view the lining of the uterus during the procedure. During a hysteroscopy, the doctor inserts a thin, lighted flexible tube in the vagina, through the cervix, and into the uterus.

    Once endometrial tissue has been removed either during a biopsy or D&C, the sample is checked for cancer cells, endometrial hyperplasia, and other conditions. In the past, there was concern that a D&C would push cancer cells out of the uterus into other reproductive organs. However, research studies have shown that this has no effect on patients who received a D&C combined with a hysteroscopy.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, additional testing will be performed to describe how far the disease has grown. This helps to categorize the disease by stage and directs the type of treatment that will be needed.

The next section in this guide is Stages and Grades. It explains the system doctors use to describe the extent of the disease. Or, use the menu to choose another section to continue reading this guide.