Uterine Sarcoma: Diagnosis

If your healthcare provider thinks you might have uterine cancer, you will need certain exams and tests. Diagnosis starts with your healthcare provider asking you questions. Your doctor will ask you questions about:

  • Symptoms such as unusual vaginal bleeding or pelvic pain

  • Your health history, including if you've ever had pelvic radiation 

  • Your reproductive history, such as when you had your first period, if you've ever used birth control pills, how many times you've been pregnant, and if you've gone through menopause

  • Lifestyle habits, such as what you eat and how much physical activity you get 

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 doctor find out if your symptoms might be caused by something other than uterine cancer. Your doctor 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, the doctor can see the top part of your vagina and the opening of your uterus (cervix). Your doctor will then insert a small spatula or brush to scrape a sample of cells from the cervix and upper vagina. The doctor sends these cells to a lab to be looked at under a microscope to check for cancer cells.

Pelvic exam

A pelvic exam is done after the Pap test. Your doctor 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 the doctor check your uterus, ovaries, bladder, rectum, and vagina. They are checked for lumps or anything else unusual. 

Transvaginal ultrasound

An ultrasound probe is inserted into your vagina. Images then show up on a nearby screen. This can help your doctor see the thickness of the uterine lining and any tumors in the uterus or in the muscle wall of the uterus. Fluid may be is inserted into the uterus. This is to help show the lining more clearly. This procedure is called a sonohysterogram or saline-infused sonogram. You may have cramping, spotting, or watery discharge after the procedure.  

Endometrial biopsy

A biopsy of the endometrial lining can show if you have uterine sarcoma. This procedure is similar to getting a Pap smear. It is usually done in your doctor's office. In most cases, you will not need numbing medicine (anesthesia). In some cases, your doctor may use a local anesthetic. If you need general anesthesia so that you will be asleep, then the biopsy is done in a hospital or an outpatient surgery center. Like the Pap smear, your doctor uses a speculum to hold your vagina open. Then he or she inserts a thin tube through your vagina and cervix into your uterus to get a bit of tissue. You may have spotting or bleeding for several days afterward. 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 & curettage (D&C)

A D&C is another kind of biopsy. It is often done when larger amounts of tissue samples are needed for testing 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. Or you may be given a sedative plus local or regional anesthesia. Your vagina is held open with a speculum. Then your cervix is opened (dilated) to allow special tools to be passed into the uterus. The doctor will take samples of the lining of the uterus (endometrium). 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. You may have cramps and bleeding after a D&C. 

Hysteroscopy 

This is a procedure that lets your doctor to 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 doctor'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.