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Doctors use many tests to diagnose cancer and find out if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. As with all types of cancer, early detection and treatment is important. Your doctor may consider these factors when choosing a diagnostic test:
- Age and medical condition
- Type of cancer suspected
- Severity of symptoms
- Previous test results
Pelvic examination. The doctor feels the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum to check for any unusual changes. A Pap test, often done with a pelvic examination, usually neither finds nor diagnoses uterine cancer. However, a Pap test may occasionally find abnormal glandular cells which are often caused by uterine cancer.
In addition to a physical examination, the following imaging tests may be used to diagnose 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.
X-ray. An x-ray is a way to create a picture of the structures inside of the body using a small amount of radiation.
Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a vein to provide better detail.
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. The sample removed during the biopsy is analyzed by a pathologist (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 one minute. Afterward, the woman may have cramps and vaginal bleeding. These symptoms will go away 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 may still need a dilation & curettage (D&C; see below) even if no abnormal cells are found during the biopsy.
D&C. A D&C is a procedure to remove tissue samples from the uterus. A woman is given anesthesia during the procedure. 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.
Learn more about what to expect when having common tests, procedures, and scans.
After these diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging. Learn more about the first steps to take after a diagnosis of cancer.