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Uterine cancer

Diagnosing uterine cancer

A thorough and accurate cancer diagnosis is critical to determining a uterine cancer patient’s treatment plan. Our multidisciplinary team of cancer experts uses a broad range tests and tools designed for diagnosing uterine cancer. Each patient’s cancer type, stage and overall health are considered when developing a treatment plan tailored to that patient’s needs and goals. Throughout treatment, imaging and laboratory tests will also be used monitor the response to treatment, and our cancer experts will modify the care plan when needed.

Common tests designed for diagnosing uterine cancer include:

Pelvic exam

A pelvic exam is typically used early in the diagnosis of uterine cancer to check for lumps that need to be examined further with advanced imaging technology.

Biopsy

An endometrial biopsy is a common diagnostic test for uterine cancer. During this procedure, a sample of cells is removed from the inside lining of the uterus and sent to the laboratory for examination under a microscope. This procedure may be performed in a doctor’s office or in an outpatient operating room.

Sentinel lymph node biopsy

Sentinel lymph node biopsy is used to diagnose and stage cancer by helping to determine whether the cancer has spread (metastasized). During a sentinel lymph node biopsy, a radioactive substance and/or a dye is injected near the tumor site. The first lymph nodes that absorb the dye are identified as sentinel lymph nodes, because they are the first lymph node drainage to which cancer is most likely to spread from a primary tumor. More than one lymph node may be considered a sentinel lymph node.

Uterine cancer spreads to the lymph nodes in about 15 percent of women with cancer that otherwise seems confined to the uterus. As a diagnostic tool, sentinel lymph node biopsy may offer greater sensitivity to help determine if cancer has spread beyond the uterus. Removing only one or two lymph nodes as a sentinel node biopsy may decrease complications.

Dilation & curettage (D&C) with hysteroscopy

During a dilation & curettage (D&C) procedure, your doctor will first dilate the cervix. Then, your doctor insert the hysteroscope to examine the inner uterine cavity. This is followed by biopsy (curettage) of the uterus lining. The tissue is then examined by pathologists under a microscope to determine a treatment plan. This is an outpatient procedure than does not require incisions. A D&C is usually performed under general anesthesia.

When biopsy results are unclear or enough tissue cannot be removed, your doctor may perform a D&C to detect uterine cancer. This procedure is often performed with a hysteroscopy. A hysteroscope is a small microscope than can easily be placed in the uterus to ensure the correct areas are biopsied.

Imaging tests

Ultrasound: Also known as sonography, an ultrasound is an imaging test that uses high-frequency sound waves to create pictures of internal organs. By capturing images in real time, ultrasound exams reveal the structure and movement of organs such as the heart, blood vessels, kidneys and liver. Unlike X-rays, ultrasound exams do not use radiation. The sound that tumors produce is different than healthy tissues, which helps us identify a uterine tumor.

CT scan: Also known as a computed axial tomography scan, a CT scan is an X-ray procedure that uses a computer to produce three-dimensional, cross-sectional images of the uterus. Unlike conventional X-rays, CT scans provide exceptionally detailed images of the bones, organs and tissues. X-rays are taken from many angles and combined to create a cross-sectional image.

MRI: An MRI is an imaging tool designed to create detailed, cross-sectional pictures of the inside of the body. Using radiofrequency waves, powerful magnets and a computer, MRI systems may distinguish between normal and diseased tissue. When diagnosing uterine cancer, an MRI may be more effective than a CT scan, because an MRI may be better at looking at the various layers of the uterus wall.

Lab tests

Advanced genomic testing: The most common lab test for uterine cancer is the genomic tumor assessment, a test that examines a tumor to look for DNA alterations that are driving the growth of cancer. By identifying the mutations that occur in a cancer cell's genome, we can better understand the tumor behavior, and we may be able to tailor your treatment based on these findings.

CA-125 test: CA-125 is a protein in the blood. High amounts of CA-125 may indicate uterine, ovarian, fallopian tube or peritoneal cancer, as well as less serious conditions, such as endometriosis or inflammation in the abdomen. We often use this test in combination with other diagnostic methods. A CA-125 test is also often used during cancer treatment. High levels of CA-125 that begin to decline may indicate the treatment is having a positive effect. If the level instead continues to rise, your doctor may consider changing your treatment regimen.

Next topic: How is uterine cancer treated?