Tests for cancer of the uterus

Your doctor will usually start with a physical examination and ultrasound of the pelvic area, but cancer of the uterus (endometrial cancer) can only be diagnosed by removing a tissue sample for checking (biopsy). Cervical screening tests (formerly called Pap smears or tests) are not used to diagnose this cancer.

Learn more about:

• Pelvic examination
• Pelvic ultrasound
• Endometrial biopsy
• Hysteroscopy and biopsy
• Further tests

Pelvic examination

The doctor will feel your abdomen (belly) to check for swelling and any masses. To check your uterus, they will place 2 fingers inside your vagina while pressing on your abdomen with their other hand. You may also have a vaginal or cervical examination where a speculum is inserted into your vagina. A speculum separates the walls of the vagina; it is the same instrument used in a cervical screening test. You can ask for a family member, friend or nurse to be present during the examination.

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. A technician called a sonographer performs the scan. It can be done in 2 ways, and often you have both types at the same appointment.

Abdominal ultrasound

The bladder needs to be full to get a clear picture of the uterus, so you will be asked to drink water before the appointment. For the ultrasound, you will lie on an examination table while the sonographer moves a small handheld device called a transducer over your abdomen.

Transvaginal ultrasound

You don’t need a full bladder for this type of ultrasound. The sonographer inserts a transducer wand into your vagina. It will be covered with a disposable plastic cover and gel to make it easier to insert. You may find a transvaginal ultrasound uncomfortable, but it should not be painful.

If you feel embarrassed or concerned about having a transvaginal ultrasound, talk to the sonographer beforehand. You can ask for a female sonographer or to have someone in the room with you (e.g. your partner, a friend or relative) if that makes you feel more comfortable.

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 about 10–15 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. Your doctor may advise you to take some pain medicine before the procedure to reduce this discomfort.

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

A hysteroscopy allows the specialist to see inside your uterus, examine the lining for abnormalities and take tissue samples (biopsy). It will usually be done under a general anaesthetic as day surgery in hospital.

The doctor will look inside the uterus by inserting a thin tube with a tiny light and camera (called a hysteroscope) through your vagina into the uterine cavity. Your cervix will also be gently widened (dilated) and some tissue will be removed from the uterine lining (called a dilation and curettage or D&C). 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.

The tissue sample will be sent to a laboratory, and a specialist doctor called a pathologist will look at the cells under a microscope. The pathologist will be able to confirm whether or not the cells are cancerous, and which type of cancer of the uterus it is.

Further tests

After diagnosis, you may have blood tests to check your general health. Your doctor may also arrange for you to have one or more imaging tests to see if the cancer has spread outside the uterus. These may include a:

• CT (computerised tomography) scan
• MRI (magnetic resonance imaging) scan
• PET–CT scan (this combines positron emission tomography with a CT scan).

Check with your doctor or medical imaging provider if, and how much, you will have to pay for these tests.

→ READ MORE: Staging and prognosis for cancer of the uterus