Uterine cancer
Diagnosing uterine cancer
Cancer of the uterus is diagnosed through a combination of tests. Learn how these tests work, what the results mean, and how staging guides treatment decisions.
Last updated:
Sources and references 
Your doctor will usually start with a physical examination and ultrasound of the pelvic area, but cancer of the uterus can only be diagnosed by removing a tissue sample for testing (biopsy). Cervical screening tests (formerly called Pap smears or tests) are not used to diagnose this cancer.
Pelvic examination
The doctor will feel your abdomen (belly) to check for swelling and any masses. To check your uterus, they will place 2 fingers inside your vagina while pressing on your abdomen with their other hand. You may also have a vaginal or cervical examination where a speculum is inserted into your vagina. A speculum separates the walls of the vagina; it is the same instrument used in a cervical screening test. You can ask for a family member, friend or nurse to be present during the examination.
Pelvic ultrasound
A pelvic ultrasound uses soundwaves to create a picture of the uterus and ovaries. The soundwaves echo when they meet something dense, like an organ or tumour, then a computer creates a picture from these echoes. A technician called a sonographer performs the scan. It can be done in 2 ways, and often you have both types at the same appointment.
Abdominal ultrasound – The bladder needs to be full to get a clear picture of the uterus, so you will be asked to drink water before the appointment. For the ultrasound, you will lie on an examination table while the sonographer moves a small handheld device called a transducer over your abdomen.
Transvaginal ultrasound – You don’t need a full bladder for this type of ultrasound. The sonographer inserts a transducer into your vagina. It will be covered with a disposable plastic cover and gel to make it easier to insert. You may find a transvaginal ultrasound uncomfortable, but it should not be painful.
If you feel embarrassed or concerned about having a transvaginal ultrasound, talk to the sonographer beforehand. You can ask for a female sonographer or to have someone in the room with you (e.g. your partner, a friend or relative) if that makes you feel more comfortable.
If you have had an abdominal ultrasound, you will usually also need a transvaginal ultrasound as it provides a clearer picture of the uterus.
A pelvic ultrasound appointment usually takes 15–30 minutes. The pictures can show if any masses (tumours) are present in the uterus. If anything appears unusual, your doctor will suggest you have a biopsy.
Endometrial biopsy
This type of biopsy can be done in the specialist’s office and takes about 10–15 minutes. A long, thin plastic tube called a pipelle is inserted into your vagina and through the cervix to gently suck cells from the lining of the uterus. This may cause some discomfort, similar to period cramps. Your doctor may advise you to take some pain medicine before the procedure to reduce this discomfort.
The sample of cells will be sent to a specialist doctor called a pathologist for examination under a microscope. If the results of an endometrial biopsy are unclear, you may need another type of biopsy taken during a hysteroscopy.
Hysteroscopy and biopsy
A hysteroscopy allows the specialist to see inside your uterus, examine the lining for abnormalities and take tissue samples (biopsy). It will usually be done under a general anaesthetic as day surgery in hospital.
The doctor will look inside the uterus by inserting a thin tube with a tiny light and camera (called a hysteroscope) through your vagina into the uterine cavity. Your cervix will also be gently widened (dilated) and some tissue will be removed from the uterine lining (called a dilation and curettage or D&C). You will stay in hospital for a few hours and are likely to have period-like cramps and light bleeding for a few days afterwards.
The tissue sample will be sent to a laboratory, and a specialist doctor called a pathologist will look at the cells under a microscope. The pathologist will be able to confirm whether or not the cells are cancerous, and which type of cancer of the uterus it is.
Further tests
After diagnosis, you may have blood tests to check your general health. Your doctor may also arrange for you to have one or more imaging tests to see if the cancer has spread outside the uterus. These may include a CT (computerised tomography) scan; MRI (magnetic resonance imaging) scan; and/or PET–CT scan (this combines positron emission tomography with a CT scan). Check with your doctor or medical imaging provider if, and how much, you will have to pay for these tests.
Staging and grading cancer of the uterus
Staging is a way to describe the size of the cancer and whether it has spread to other parts of the body. In some cases, the scans can show if the cancer has spread, but it is often not possible to be sure of the stage until after surgery.
Grading describes how the cancer cells look compared with normal cells and estimates how fast the cancer is likely to grow.
Knowing the stage and grade helps your doctors recommend the best treatment for your situation. The table on the opposite page shows how endometrial cancers are staged and graded. Uterine sarcomas are staged differently, so discuss this with your doctor.
Tests after surgery
Cancer of the uterus is often removed with surgery. The removed tissue is sent to a laboratory for further testing to find out more about the type and features of the cancer. Some people may also have genetic tests to help doctors decide if any treatment is needed after surgery.
Pathology assessment
The pathologist will check the sample to assess: how deeply the tumour is growing into the uterine wall (myometrial invasion); how quickly the cells are growing (grade); the type of cells that make up the cancer; and whether any lymph nodes contain cancer cells. They will also use special chemicals (called stains) to look for any gene changes in the cancer cells. This is called genomic or molecular testing. The results of these tests help your doctors to work out what types of treatment may be helpful and if further genetic tests may be needed.
Stages of endometrial cancers
The 4 stages of endometrial cancers may be divided into sub-stages, such as A, B and C, which indicate increasing amounts of tumour.
| stage 1 | The cancer is found only in the uterus. | early or localised cancer |
| stage 2 | The cancer has spread from the uterus to the cervix. | regionalised cancer |
| stage 3 | The cancer has spread beyond the uterus/cervix to the ovaries, fallopian tubes, vagina, or lymph nodes in the pelvis or abdomen. | regionalised cancer |
| stage 4 | The cancer has spread further, to the bladder, bowel or rectum, throughout the abdomen, to other parts of the body such as the bones or lung, or to lymph nodes in the groin. | metastatic or advanced cancer |
Grades of endometrial cancers
| grade 1 (low grade) | The cancer cells look slightly abnormal and are slow growing. |
| grade 2 (moderate grade) | The cancer cells look moderately abnormal and are growing at a moderate rate. |
| grade 3 (high grade) | The cancer cells look more abnormal and tend to be faster growing than lower-grade cancers. |
Genetic tests
For endometrial cancer, the tissue sample may be checked for inherited gene changes. For example, a small number of endometrial cancers are caused by Lynch syndrome. This is linked to an inherited fault in the genes that help the cell’s DNA repair itself (called deficient mismatch repair or dMMR). People with Lynch syndrome are at increased risk of other cancers, so it’s important for you, your family and your doctors to know about this. For more information, visit cancervic.org.au/ cancer-information/genetics-and-risk/lynch-syndrome.
Also, knowing if the tumour contains a faulty gene will help your treatment team decide if further treatment may be needed after surgery.
Prognosis
Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis with your doctor, but it is not possible for anyone to predict the exact course of the disease. Instead, your doctor can give you an idea about the general outlook for people with the same type and stage of cancer of the uterus.
To work out your prognosis, your doctor will consider test results, the type of cancer of the uterus, the rate and depth of tumour growth, the likelihood of response to treatment, and factors such as your age, level of fitness and medical history.
In general, the earlier cancer of the uterus is diagnosed, the better the prognosis. Most early-stage cancers of the uterus have high survival rates. If cancer is found after it has spread to other parts of the body (advanced cancer), there is a higher chance of the cancer coming back after treatment or continuing to grow.
Key points about diagnosing cancer of the uterus
Main tests
If you have symptoms of cancer of the uterus, initial tests may include:
- pelvic examination – your doctor feels the abdomen (belly) and checks the uterus by placing 2 fingers inside the vagina
- vaginal or cervical examination – your doctor uses a speculum to help see inside the vagina or cervix
- pelvic ultrasound – you may have an abdominal ultrasound or transvaginal ultrasound, or both
- endometrial biopsy – your doctor takes a sample of cells from the uterus using a long, thin plastic tube called a pipelle
- hysteroscopy and biopsy – this allows your doctor to see inside your uterus and remove a sample of tissue from the uterine lining.
Other tests
Other tests can give more information about the cancer and often help guide treatment. These tests may include: blood tests, CT, MRI and PET–CT scans.
Staging and tests after surgery
- Endometrial cancer will be given a stage and grade, which will be confirmed after surgery.
- The stage describes how far the cancer has spread. The grade describes how fast the cancer is growing.
- After surgery, the removed tissue will undergo pathology assessment and, sometimes, genetic testing. The results will guide further treatment.
Prognosis
Prognosis means the expected outcome of a disease. If cancer of the uterus is diagnosed early, it can usually be successfully treated.
Sources and references
This edition has been developed by Cancer Council NSW on behalf of all other state and territory Cancer Councils as part of a National Cancer Information Subcommittee initiative. All updated content has been clinically reviewed by Professor Alison Brand, Clinical Professor, The University of Sydney and Director, Department of Gynaecological Oncology, Westmead Hospital, NSW. This edition is based on the previous edition, which was reviewed by the following panel: A/Prof Orla McNally, Consultant Gynaecological Oncologist, Director Oncology/Dysplasia, Royal Women’s Hospital, Honorary Clinical Associate Professor, University of Melbourne, and Director of Gynaecology Tumour Stream, Victorian Comprehensive Cancer Centre, VIC; A/Prof Yoland Antill, Medical Oncologist, Peninsula Health, Parkville Familial Cancer Centre, Cabrini Health and Monash University, VIC; Grace Guerzoni, Consumer; Zeina Hayes, 13 11 20 Consultant, Cancer Council Victoria; Bronwyn Jennings, Gynaecology Oncology Clinical Nurse Consultant, Mater Hospital Brisbane, QLD; A/Prof Christopher Milross, Director of Mission and Radiation Oncologist, Chris O’Brien Lifehouse, NSW; Mariad O’Gorman, Clinical Psychologist, Liverpool Cancer Therapy Centre and Bankstown Cancer Centre, NSW. We would like to thank all the health professionals, consumers and editorial teams who have worked on current and previous editions of this title.
Uterine Cancer
Cancer Council 13 11 20
Call us to talk to a specially trained health professional for free and confidential support and information.