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Diagnosis

Early and accurate diagnosis of uterine cancer can help increase the chances for successful treatment. At AOI, the best hospital for diagnosis of uterine cancer in India, we use the most advanced techniques and state of the art technology to diagnose uterine cancer and find out the exact extent of the disease. This allows us to offer you the best treatment for uterine cancer.

How is uterine cancer diagnosed?

If a woman shows any symptom that may signal uterine cancer, then the doctor will examine her, besides asking questions related to general health; lifestyle; and family history of cancer.

In addition to physical examination, the doctor may also suggest any of the following confirmatory tests to diagnose uterine cancer:

Pelvic exam
Imaging tests
Blood tests
Biopsy
Dilation and curettage (D&C)
Lab tests

Pelvic examination

Doctors perform a pelvic exam to examine a woman’s pelvis and surrounding organs. Typically, a pelvic exam is the first step in diagnosing gynecologic cancers, which includes uterine cancer. Pelvic examination test is sometimes performed to determine the exact type and stage of cancer.

Why might I need to undergo pelvic exam for uterine cancer?

As mentioned above, when it comes to uterine cancer diagnosis, pelvic exam is the first step. So if you experience any gynecological symptom such as pelvic pain, unusual vaginal bleeding, abnormal vaginal discharge or urinary problems, your doctor may prescribe you a pelvic exam. The test is also recommended if you have increased risk or family history of uterine cancer.

The test helps your gynecologic oncologist to determine the exact type and stage of cancer.

How do I get ready for a pelvic exam?

Before the exam, the patient is asked to empty her bladder. This is to avoid any kind of discomfort. She is then asked to put on a gown. Also, when making an appointment for a pelvic exam, patient should make sure she is not on period. Other than that there’s nothing much that a patient needs to do before the pelvic exam test.

What happens during a pelvic exam?

During a pelvic exam, which generally lasts ten minutes, the doctor feels the patient’s organs by pressing down on different parts of the stomach and pelvic area.

Once the external exam is complete, the doctor inserts a speculum into the vagina so that the vagina and cervix are visible. Followed by this, the doctor places two fingers inside the vagina and uses the other hand to press down on the pelvic organs in order to note irregularities in the uterus or ovaries.
The test may feel uncomfortable, but it should not be painful.

How do you receive the results of a pelvic exam?

The moment your pelvic exam gets over, your doctor will be able to tell you about any abnormalities that were found.

What are the benefits vs. risks of the pelvic exam?

The pelvic exam is essential for determining a woman’s sexual and reproductive health. It helps in detecting life-threatening conditions, such as cancer. However, sometimes the test may not be able to diagnose the very early stage cancers.

There are no risks associated with the test but many women find the pelvic exam uncomfortable.

Pelvic exam result accuracy

Although, the pelvic exam proves to be beneficial, early uterine tumors are often difficult to detect during the test.

Endometrial biopsy

What is endometrial biopsy?

Endometrial biopsy is the removal of a small amount of tissue for examining it under a microscope. While other tests can only suggest the presence of cancer, it’s endometrial biopsy that can make a definite diagnosis.

Endometrial biopsy results

Endometrial biopsy result is usually considered to be an accurate way to diagnose uterine cancer.

Endometrial biopsy pain

The procedure may be slightly painful as the tube is passed through the cervix to extract the tissue sample from the lining of the womb. But it is exactly the same cramping pain as is experienced during periods. So for most women the pain is bearable.

Endometrial biopsy results interpretation

The endometrial tissue samples are evaluated by a pathologist, who will use a microscope to determine whether cancer cells are present and if so, confirm a uterine cancer diagnosis.

What are endometrial biopsy procedure steps?

Endometrial biopsy is a quick test, and it takes about 10 to 15 minutes. The test is done on an outpatient procedure.

For an endometrial biopsy, the doctor removes a small sample of tissue with a very thin tube which is inserted into the uterus through the cervix. The tissue is then removed with suction. After the procedure, the woman may experience cramps and vaginal bleeding but these symptoms usually go away soon and can be reduced by taking a nonsteroidal anti-inflammatory drug as directed by the doctor.

Endometrial biopsy pain level

As mentioned above, a woman may experience some cramps or period like pain in the lower part of the tummy. This may last for a day or two after the procedure. However, most women tolerate the procedure well.

What happens if my endometrial biopsy is abnormal?

The abnormal biopsy does not necessarily mean you have uterine cancer. It could be abnormal due to non-cancerous growth called polyps. In case abnormal cells are detected, you may be asked to take hormones. Besides, your doctor will discuss about the best treatment strategy based on your results, and you’ll be asked for a follow-up visit in a few weeks time.

I am still bleeding, 5 days after endometrial biopsy. What should I do?

It’s normal to have some light bleeding, like a period or bloating after the endometrial biopsy. This does not last longer than a few days. Use a sanitary towel if you need one. But if you experience heavy bleeding, contact your doctor immediately.

I am experiencing infection after endometrial biopsy. Is it normal?

Occasionally, an infection can develop post endometrial biopsy. If you experience severe pain, have a lot of bleeding, or develop a smelly discharge or fever in the week after the procedure, then see your doctor immediately.

Turnaround time for endometrial biopsy results

Endometrial biopsy result time will depend on your local laboratory, but usually it takes between one and four weeks. They would normally tell you at the time of the biopsy how this will happen – it might be by phone, online or you may have to collect it in person.

Dilation and Curettage (D&C)

If an endometrial biopsy does not provide clear results or if a uterine cancer diagnosis is not definite, a dilation and curettage (D&C) test may be performed.

During dilation and curettage procedure for uterine cancer, a pathologist examines the extracted tissue samples from the uterus under a microscope to check for abnormal cells. The test is often done in combination with a hysteroscopy so that the doctor is able to view the lining of the uterus during the procedure.

During hysteroscopy, the doctor inserts a hysteroscope, a thin, flexible tube with a light on it through the cervix into the vagina and uterus.

D&C procedure

During a dilation and curettage (D&C) procedure, your doctor will first dilate the cervix, followed by which she will insert the hysteroscope to examine the inner uterine cavity. This is followed by a biopsy or curettage of the uterus lining. The tissue is then examined by the pathologist under a microscope to check for abnormal cells and determine a treatment plan. A D&C is an outpatient procedure and is usually performed under general anesthesia. The procedure does not require any incision.

Dilation and Curettage side effects

After D&C, there are possible side-effects involved with the procedure. These include:

Cramping
Spotting or light bleeding

But in case you experience heavy or prolonged bleeding, fever, pain, foul smelling discharge, etc., contact your doctor.

Recovery after dilatation and curettage

After D&C, you will feel drowsy in case you were given general anesthesia. However, you will be able to return to your normal activities in a day’s time. Also, some women may experience mild cramping or spotting for a few days but this is normal. Besides, you can expect a change in the timing of your next menstrual period.

Computerized Tomography (CT)

When is Computed Tomography (CT) done?

A CT scan is generally prescribed if you show signs or symptoms of uterine cancer. Also, this might help your doctor to plan your surgery as a CT scan can be used to measure the tumor’s size.

Sometimes, for better detail, a special dye called a contrast medium is given before the scan.

How do I prepare for a computed tomography (CT)?

If your doctor ordered a CT scan without a contrast or dye, you can eat, drink and take your prescribed medications prior to your exam. But, if your doctor ordered a CT scan with contrast, you will be asked not to eat anything for a few hours prior to the imaging test. You are encouraged to drink clear liquids, though.

How is this test performed?

During a CT scan, a patient is made to lie in a tunnel-like machine. As the inside of the machine rotates and takes a series of x-rays from different angles, these pictures are then sent to a computer, where they’re combined to create images of slices or cross-sections, of the body. At times they are also combined to produce a 3-D image of a particular area of the body.

What to expect after computed tomography (CT)?

If contrast dye was used during your procedure, you may be monitored for a specific period of time for any side effects or reactions to the dye which can cause itching, swelling, rash, or difficulty breathing.

How do you receive the results of computed tomography (CT)?

After the procedure is done, you will get your results in a week or two weeks time.

Computed tomography (CT) result accuracy

CT of the abdomen and pelvis is the first line of imaging modality for staging the cancer. This helps to select treatment options and assess disease response in uterine cancer.

Transvaginal Ultrasound

When is transvaginal ultrasound done?

Transvaginal ultrasound is an internal examination. So if your doctor suspects you have uterine cancer, you may be asked to get a transvaginal ultrasound, hysteroscopy or examination of the lining of the uterus and biopsy. Please note that a pap test is not used to diagnose uterine cancer.

How do I prepare for a transvaginal ultrasound?

A transvaginal ultrasound hardly requires any preparation on your part. Once you’re in the examination room, you will be asked to put on a gown.
Depending on your doctor’s instructions, you may be asked to either keep your bladder empty or partially full. A full bladder allows for a clearer picture of your pelvic organs.

If you’re spotting or are on your menstrual cycle, you will have to remove any tampon you’re using before the ultrasound.

Before the ultrasound procedure starts, a small tube may be used to put salt water into the uterus. This procedure is called a saline infusion sonogram or hysterosonogram and it helps the doctor to see the uterine lining more clearly.

How is this test performed?

For this test, the TVUS probe is put into the vagina. Images from the TVUS allow the surgeon to see if the uterus contains a tumor, or if the endometrium is thicker than usual or if the cancer is growing into the muscle layer of the uterus, called myometrium.

During the procedure, the patient is asked to lie down on their back on the examination table and bend their knees.

Your doctor covers the ultrasound wand with a condom and lubricating gel, and then inserts it into the vagina which may result in some sort of discomfort.
Once the transducer is inside of the patient, sound waves transmit pictures of the inside of pelvis and other organs onto a monitor.

What to expect after tranvaginal ultrasound?

There are no known risks associated with transvaginal ultrasound. Infact, performing transvaginal ultrasound on pregnant women is also safe, this is because no radiation is used in this imaging technique.

When the transducer is inserted into the vagina, the patient may feel pressure and some sort of discomfort but it should go away once the procedure is complete.

How do you receive the results of transvaginal ultrasound?

A transvaginal ultrasound helps diagnose multiple conditions, including uterine cancer. You might get your results immediately or if the results require a bit more interpretation, it could take a couple of days.

Transvaginal ultrasound result accuracy

Transvaginal ultrasound is considered to be the first approach in evaluating a postmenopausal woman with an initial episode of bleeding. However, it may not be an appropriate screening tool for endometrial cancer in postmenopausal women without bleeding.

Advanced genomic testing

What is genomic testing for uterine cancer?

This is by far the most common lab test for uterine cancer. The test examines the molecular composition of a tumor and helps to find gene mutations that may be driving a cancer’s behavior. The test also helps the doctor to tailor treatment based on these findings.

How is genomic testing done?

In advanced genomic testing, a biopsy is taken of the patient’s tumor from which the cancer cells are isolated and extracted, and then the cancer cells’ DNA is sequenced in the lab. Then the sophisticated equipment is used to scan the sequenced genetic profile for abnormalities that dictate how the tumor functions. If identifiable abnormalities are found, they are analyzed to determine whether they match known mutations or not.

Will genetic testing tell me if I have cancer?

No genetic test can reveal if you will develop cancer for sure. But it can tell you if you are at a higher risk than most people.

Genetic testing indicates your chance of developing cancer in your lifetime. It does this by searching for specific changes in your genes, chromosomes, or proteins, called mutations.

Genetic testing can help to:

Predict your risk of a particular disease
Find if you have genes that may pass increased cancer risk to your children
Provide information to guide your health care

What is the difference between genetic testing and genomic testing?

Genetic testing and genomic testing are often used interchangeably but are actually very different terms. Genetics refers to the genes an individual is born with that are inherited from past generations. The genetic test helps to determine whether a person has inherited gene mutations that may increase the risk of cancer. Genomics, on the other hand, refers to the molecular composition of a tumor.

CA-125 test

CA-125 to detect uterine cancer

CA-125 is a protein released into the bloodstream by many, but not all, endometrial and ovarian cancers. Also, if a woman has endometrial cancer, a very high blood CA-125 level suggests that the cancer has likely spread beyond the uterus.

What is a CA-125 blood test?

CA-125 is a protein released in the bloodstream. High level of CA-125 may indicate the uterine, ovarian, fallopian tube or peritoneal cancer, as well as less serious conditions, such as endometriosis or inflammation in the abdomen. Also, very high level may indicate the cancer has spread beyond the uterus or has come back after the treatment.

CA-125 blood test accuracy

CA-125 is not considered to be a completely reliable test for uterine cancer as some other conditions of the womb and ovaries also produce CA-125.
Therefore, doctors generally perform the CA-125 blood test in combination with a transvaginal ultrasound.

What is the highest CA 125 level?

Results of the CA-125 test are measured in units per milliliter (U/ml) and the normal value is always less than 46 U/mL.

If your CA-125 level is higher than normal, you may either have a benign condition or ovarian, endometrial, peritoneal or fallopian tube cancer. Your doctor may recommend other tests and procedures to further determine your diagnosis.

Why is my doctor testing my blood for CA-125?

As mentioned, uterine cancer sometimes releases this protein into the bloodstream which shoots up your CA-125 level. So if your doctor suspects you of having uterine cancer, you may be asked to get this blood test.

Magnetic Resonance Imaging (MRI)

When is Magnetic Resonance Imaging (MRI) done?

If your doctor suspects or has determined you have uterine cancer, you may have a body MRI to see if it has spread. MRI produces detailed pictures of your uterus, lymph nodes and other abdominal tissues and is useful for cancer staging and treatment planning.

How do I prepare for a Magnetic Resonance Imaging (MRI)?

If you are scheduled for MRI exam, you can eat normally. You can even continue to take your usual medications unless otherwise instructed by your doctor. But if you are diabetic or on any medications, it is advisable to let your doctor know in advance.

How is this test performed?

MRIs employ powerful magnets which produce a strong magnetic field to make images. A contrast material may be injected into a vein before the scan to make lymph nodes and other tissues show up more clearly.
MRI is often used in women with low-grade uterine cancer to see how far the cancer has spread into the wall of the uterus as this can help to determine whether a woman’s fertility can be preserved.

What to expect after Magnetic Resonance Imaging (MRI)?

If you feel pain or any unusual symptom following the exam, contact your doctor. You will feel active even after the MRI, unless you were given a sedative. Your MRI test will be reviewed by a radiologist.

How do you receive the results of Magnetic Resonance Imaging (MRI)?

After the procedure is done, you will get your results in a week or two weeks time.

Magnetic Resonance Imaging (MRI) result accuracy

When it comes to diagnosing uterine cancer, MRI may be more effective than a CT scan because MRI scans the various layers of the uterus wall. Besides MRI is often used in women with low-grade uterine cancer to see how far the cancer has spread.

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