Diagnosing Uterine Cancer

Diagnosing endometrial cancer is more complex than simply determining whether malignant cells are present in the uterus. Physicians must also evaluate what type of uterine cancer it is, whether it involves certain genetic mutations, and how far it has spread in the body. It’s vital to answer these questions before developing a patient’s treatment plan.

At Siteman, we excel at seeing patients in a timely manner so as not to delay diagnosis and treatment. When a patient comes to see us, your records, tests, and previous biopsies will be reviewed again by our pathologists to make sure we have the correct diagnosis.

Because Siteman is a NCI-designated Comprehensive Cancer Center with an Endometrial SPORE, many patients travel great distances for our expertise. For patients’ convenience, we try to make visits with us as efficient as possible. This means coordinating multiple tests and appointments on the same day to minimize the number of trips and time spent traveling to one of our locations.

What diagnostic tests does Siteman use?

Diagnosing uterine, or endometrial, cancer starts with a simple exam in an ob-gyn’s office. During the exam, your physician will palpate your lower abdomen, checking for anything abnormal in your uterus or ovaries.

If your ob-gyn suspects something could be wrong, he or she may recommend an ultrasound to evaluate further. These ultrasounds are often performed trans-vaginally, which means that the ultrasound wand is placed inside the vagina for a closer view of the pelvic organs. Patients don’t need to do any special preparation for the exam, and they are free to resume their usual activities when it is over.

If the ultrasound indicates a tumor could be present, your physician will likely want to biopsy the tissue inside your uterus. This procedure is called an endometrial biopsy. During the biopsy, your physician will insert a tiny tube through your cervix and into your uterus. Then, they will remove a small sample of tissue through the tube so it can be checked for malignant cells in a laboratory. An endometrial biopsy is a minor procedure that can be performed in an ob-gyn’s office. It does not require dilation of the cervix.

In some cases, your physicians may decide to perform a dilation and curettage, or D&C, instead of an endometrial biopsy. A D&C may be preferred if your physicians need a larger sample of uterine tissue to make a diagnosis.

During a D&C, the cervix is dilated, allowing the physician greater access to the inside of the uterus. Then, the physician will use a tiny tool called a curette to remove tissue from the walls of the uterus. A D&C is typically performed as an outpatient procedure at a hospital. You’ll be given anesthesia during the test to make you more comfortable. You’ll want to take a day or two to recuperate afterwards.

After performing a biopsy or D&C, your care team will run tests to learn whether benign or malignant cells are present in your body. They’ll also conduct genetic testing on the tissue to screen for any somatic mutations. Somatic mutations are a type of mutation that arise within individual cells, including cancer cells. They cannot be passed from parents to children. Determining whether somatic mutations are present in your cancer cells can help your physicians plan an effective course of treatment for you.

Staging uterine cancer

If cancer has been found, it is important to determine how advanced it is and how far it has spread in the body. This is called staging the cancer.

A few more tests may be necessary to correctly stage your endometrial, or uterine, cancer. These might include a CT scan, an MRI, or a PET scan. In general, endometrial cancer is staged with surgery.

Endometrial cancers are assigned a stage from I to IV, with IV being the most advanced. Cancer caught at stage I are only located in the uterus. By stage III, the cancer has spread beyond the uterus but has not yet progressed outside of the pelvis. At stage IV, the cancer has moved outside of the pelvis into other parts of the body.