Uterine Sarcoma: Diagnosis

If your healthcare provider thinks you might have uterine cancer, you will need certain exams and tests to be sure. Diagnosing uterine sarcoma starts with your healthcare provider asking you questions. He or she will ask you about your health history, your symptoms, risk factors, and family history of disease. Your healthcare provider will also give you a physical exam.

What tests and exams might I need?

You may have one or more of these tests and exams: 

• Pap test

• Pelvic exam

• Transvaginal ultrasound

• Endometrial biopsy

• Dilation and curettage (D&C)

• Hysteroscopy

Pap test

The Pap test does not check cells from deep inside the uterus, so it doesn't help diagnose uterine sarcoma. But it can help your healthcare provider find out if your symptoms might be caused by something other than uterine cancer. Your healthcare provider will place a tool called a speculum into your vagina to hold it open. It may feel a little uncomfortable, but it shouldn't hurt. With the vagina open in this way, your healthcare provider can see the top part of your vagina and the opening of your uterus (cervix). He or she will then use a small spatula or brush to scrape a sample of cells from the cervix and upper vagina. The cells are then sent to a lab where they are looked at under a microscope to check for cancer cells.

Pelvic exam

A pelvic exam is done after the Pap test. Your healthcare provider will apply lubricant and then insert 1 or 2 gloved fingers into your vagina. He or she will use the other hand to press on your belly (abdomen). This lets your healthcare provider check your uterus, ovaries, bladder, rectum, and vagina. They are checked for lumps or anything else unusual. 

Transvaginal ultrasound

An ultrasound uses sound waves to create images on a computer screen. A small wand, called a transducer, is inserted into your vagina. Images then show up on a nearby screen. The transducer is gently moved around, and sound waves echo off the organs to create the images. This can help your healthcare provider see the thickness of the uterine lining and any tumors in the uterus or in the muscle wall of the uterus. Fluid may be put into the uterus. This is to help show the lining more clearly. This procedure is called a hysterosonogram or saline-infusion sonogram.   

Endometrial biopsy

A biopsy of the endometrial lining can show if you have cancer and, if so, the type of cancer. This procedure is similar to getting a Pap smear. It is usually done in your healthcare provider’s office. Like the Pap smear, a speculum is used to hold your vagina open. Then your healthcare provider puts a thin tube through your vagina and cervix into your uterus to get a bit of tissue. The tissue is looked at under a microscope and checked for cancer cells. If cancer is found, tests will be done to find out what type it is.  

Dilation and curettage (D&C)

A D&C is another kind of biopsy. It is often done when larger amounts of tissue are needed for testing. They may be needed because an endometrial biopsy wasn't clear or didn't get enough tissue. It is usually done in the hospital or surgical center. For this procedure, you may be given general anesthesia. This puts you in a deep sleep-like state. Or you may be given a sedative plus local anesthesia to numb the area around your cervix. Your vagina is held open with a speculum. Then your cervix is opened (dilated) to allow special tools to be passed into the uterus. Then samples of the lining of the uterus (endometrium) are removed. The tissue is looked at under a microscope and checked for cancer cells. If cancer is found, tests will be done to find out what type it is.  

Hysteroscopy 

This is a procedure that lets your healthcare provider take a biopsy of the endometrial tissue and look inside the uterus. A thin telescope-like tool and other small tools are put through the cervix and into the uterus. Growths are removed so they can be checked for cancer cells. Hysteroscopy may be done in your healthcare provider's office with a sedative. Or it may be done as an outpatient surgery with general anesthesia. If cancer cells are found in the tissue that was removed, tests will be done to find out the type of cancer. 

Other tests

If cancer cells are found, you may need other tests to see if the cancer has spread from the uterus to other parts of your body. You may have tests such as: 

• Blood tests

• Chest X-ray

• Computed tomography (CT) scans of areas of the abdomen

• An ultrasound to look at other organs inside the body

• Special exams of the bladder, colon, and rectum if cancer may have spread to these areas

Getting your test results

When your healthcare provider has the results of your tests, he or she will talk with you about the results and next steps. You may be referred to a gynecologic oncologist. This is a doctor who treats cancers in the female reproductive organs. Make sure you understand the results and what follow-up you need.