Uterine Cancer: Diagnosis

Approved by the Cancer.Net Editorial Board, 09/2020

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. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They do tests to learn whether cancer has spread to a different part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests such as CT scans (see below) 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 if 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 section describes options for diagnosing uterine cancer. 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 general health

  • The results of previous medical tests

In addition to a physical examination, the following 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 used to check for cervical cancer. Sometimes a Pap test may find abnormal glandular cells, which are caused by uterine cancer.

  • 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 analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells and tissue samples 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 a few minutes. Afterward, the woman may have cramps and vaginal bleeding. These symptoms should go away soon 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. People who have abnormal vaginal bleeding before the test may still need a dilation and curettage (D&C; see below), even if no abnormal cells are found during the biopsy.

  • Dilation and curettage (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, flexible tube with a light on it through the cervix into the vagina and uterus. After endometrial tissue has been removed, during a biopsy or D&C, the sample is checked by a pathologist for cancer cells, endometrial hyperplasia, and other conditions.

  • 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 take pictures. If the endometrium looks too thick, the doctor may decide to perform a biopsy (see above).

  • Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can 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 pill or liquid to swallow.

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can be used to measure the tumor’s size. Like with a CT scan, a special dye called a contrast medium can be given intravenously or orally before the scan to create a clearer picture. MRI is very useful for getting detailed images if the treatment plan will include hormone management (see Types of Treatment). MRI is often used in women with low-grade uterine cancer (see Stages and Grades) to see how far the cancer has grown into the wall of the uterus. Knowing this can help determine whether a woman’s fertility can be preserved.

  • Molecular testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests can help determine your treatment options.

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 discover how far the disease has grown. This helps to categorize the disease by stage and grade 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. Use the menu to choose a different section to read in this guide.