Your doctor will question you about your medical history and the symptoms you experience. In addition, he will do a physical examination of your abdomen and pelvis to look for signs indicating uterine cancer. However, these diagnostic steps can give him a suspicion of the cancer but not a confirmation.
For women who are closed to menopause and still have their menstruation, the diagnosis is more difficult; the bleeding can be a menorrhagia (abnormally heavy and prolonged menstrual period) or bleeding of a cause that has nothing to do with cancer. To rule out these non-cancerous bleeding, your doctor will do a direct pelvic examination – with a speculum- to assess your pelvic organs and check for any gynecological problems. In the absence of cancer, the test usually shows a normal cervix.
However, to confirm with certainty the presence of a uterine cancer, your doctor will recommend the following tests:
Pap test (Pap smear) – this test is done to look inside the vagina and the outside of the uterus. Your physician introduces a speculum into your vagina to take sample of cells from the cervix. A Pap test cannot reveal a uterine cancer; it is, however, a key technique to detect precancerous sign and prevent cancer of the pelvic organs.
Transvaginal ultrasound – this medical technique is painless; it consists of inserting two or three inches from the tip of a transducer into your vagina to obtain images of the uterus. This test allows your doctor to create images from different angles to get the best views of your uterus and ovaries. If any cancerous lesion is found on the endometrium, a biopsy will be performed.
Biopsy – even if the other procedures have revealed the cancer, a biopsy is usually necessary to establish with certainty the diagnosis. During the procedure, your doctor removes a small sample of tissue from the inside of the uterus for laboratory analysis. If cancer cells are found, other techniques will be performed to determine the stage of the cancer. In general, at least one of these biopsies will be performed.
- Endometrial biopsy – during this diagnostic procedure, your doctor introduces a thin, flexible tube through the cervix. He then uses a gentle suction to collect sample of tissue from the lining of the uterus. The biopsy may be performed in a hospital or at your doctor’s office.
Although rare, an endometrial biopsy may cause complications such as infections, bleeding or uterine perforation. If you experience pain or bleeding after the biopsy, call your doctor immediately.
- Dilatation and curettage – this is diagnostic technique allows your surgeon to evacuate or gradually open your cervix. Performed under local or general anesthesia, dilation and curettage allows your doctor to scrape the lining of the uterus to collect tissue sample for laboratory analysis.
Dilatation and curettage often causes pain similar to menstrual cramps a day or two after the procedure. If these problems persist for three or four days, see your doctor; it may be a sign of complications.
- Laparotomy – laparotomy is a surgical procedure consists of opening the abdomen through an incision so that the surgeon can have direct passage on the abdominal and pelvic organs. Performed under general anesthesia, laparotomy allows your surgeon to visually inspect and evaluate the tumor, surrounding tissue and lymph nodes. Laparotomy can also measure the extent of the tumor and whether it has spread or not.
Although rarely performed before the treatment, your doctor may recommend hormonal testing to see whether estrogen receptors are present in the tissue of the tumor. A positive result indicates that hormone therapy can have a positive effect against the cancer.