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Tests That Help Evaluate Uterine Cancer

Before your diagnosis, your doctor took a biopsy from your uterus to help find out if you had uterine cancer. It’s likely that your doctor has suggested that the best treatment is to have your uterus removed. If so, samples taken from your uterus after it is removed will help your doctor decide whether you need more treatment.

Once a diagnosis of uterine cancer is made, your doctor may request additional tests to learn more about your type of uterine cancer, its location, and whether it has spread. You’ll likely have these same tests whether you have endometrial cancer or uterine sarcoma, though what the doctor looks for may be different. Not all women having surgery to treat the cancer will need these tests. You should be treated by a gynecologic oncologist with advanced training in uterine cancers. 

Here are some of the tests you may have.

Transvaginal ultrasound

Ultrasound tests recreate images of our organs by using high-frequency sound waves that bounce off of internal body parts.

Illustration of transvaginal ultrasound procedure
Click Image to Enlarge

A transvaginal ultrasound lets doctors review images of the pelvic organs through a special probe inserted into your vagina. These images help your doctor to see if there are any growths or tumors in your uterus. They also help your doctor measure the thickness of the lining of the uterus. To have this test done, you lie on your back on a table. Your doctor inserts a thin probe into your vagina. It’s covered with a condom and lubricated. The doctor moves the probe around, and sound waves echo off the organs. A computer creates an image of your pelvic area based on these echoes. You may feel some pressure or mild discomfort, but this test should not be painful. If your uterus has not yet been removed, your doctor may use a catheter to put salt water into the uterus. This helps fill the uterus to create a clearer image. The images help your doctor see if there are tumors.

Cystoscopy

This test checks to see if cancer has spread to your urethra or bladder. You have this test done in a hospital or an outpatient surgery center. You may be given a local anesthetic to numb the area. Or you may be given general anesthesia so that you fall asleep and don’t feel anything. You lie flat on your back. Your doctor uses a thin tube with a light called a cystoscope. The cystoscope may also have a camera in it. He or she inserts the scope up through your urethra and into your bladder. Water is also inserted through the cystoscope. You may feel uncomfortable, and you may feel a strong need to urinate. If needed, the doctor can take a tissue sample to check for cancer. You will need a ride home after the test. You may feel a burning sensation when you urinate for a few days after the test. If your doctor suspects the cancer may be in the rectal area, a proctoscopy may be recommended. With this test, a tube with a light is inserted into the rectum and a tissue sample can be taken if needed.   

Magnetic resonance imaging (MRI)

An MRI is used to help check whether cancer has spread outside of your uterus. MRIs use radio waves and magnets to create images of your body. For this test, you lie still on a table as it passes through a long, narrow, tube-like scanner. Then the scanner rotates around you. As it moves, it directs a continuous beam of magnetic waves at the area being examined. A computer uses the data from the magnetic waves to create a three-dimensional picture of the inside of your body. You may need more than one set of images. Each one may take two to 15 minutes, so the whole scan may take an hour or more. This test is painless and noninvasive, but you will need to lie very still while the pictures are being taken. Ask for earplugs if they aren’t offered, since there is a loud thumping noise during the scan. If you’re claustrophobic (afraid of closed places), you may be given a sedative before having this test.

Preparing patient for a scan

CT scan

A CT scan can help determine if cancer has come back or if it has spread to other organs. During a CT scan, X-rays scan the pelvis in about 15 to 25 seconds. These special X-rays are 100 times more sensitive than a typical X-ray. To have the test, you lie still on a table as it gradually slides through the center of the doughnut-shaped CT scanner. Then the scanner rotates around you, directing beams of X-rays at your pelvis. A computer uses the data from the X-rays to create many pictures of your pelvis, which can be put together to create a three-dimensional picture. A CT scan is painless and noninvasive. You may be asked to briefly hold your breath one or more times during the scan. In some cases, you may be asked to drink a contrast dye four to six hours before the scan. And you may be asked not to eat anything in the time between drinking the contrast dye and the scan. The contrast dye will gradually pass through your system and exit through your bowel movements. Sometimes contrast dye is given through your vein. This may make you have a warm, flushing feeling during the injection and have a metallic taste in your mouth. Sometimes people are allergic to the intravenous contrast dye. Special medications can be given to treat and prevent a reaction, so be sure to tell your doctor if you have ever had an allergic response to dye. 

Other X-rays

A chest X-ray can show if the cancer has spread to your lungs. It may also be done before surgery to be sure you have no heart or lung problems. The procedure is quick and painless. An intravenous pyelogram (IVP) is an X-ray of your urinary tract, including your bladder, ureters, and kidneys. First, you’re injected with iodine, which acts as a contrast dye. Then, X-rays are taken over timed intervals to show the flow through the urinary tract. The test may take up to an hour. This shows if cancer has spread to that area.

Positron emission tomography (PET)

A PET scan can show small collections of cancerous cells throughout the body before they form actual tumors that can be seen on CT scan or MRI. A special, radioactive glucose dye is injected into your vein to highlight these cells. Researchers are still studying whether or not PET scans are useful in uterine cancer. At this time, this type of scan isn't commonly used by doctors who treat cancer of the uterus. 

Blood tests

Blood tests may be done several times throughout your diagnosis and treatment. Some blood tests help your doctor decide if you're healthy enough for surgery. Other blood tests help your doctor learn if cancer has spread or if treatment is working.  CA-125, for instance, is a protein that is released by a number of cancers of the reproductive organs including the ovaries and uterus. Your doctor may monitor your CA-125 levels throughout your treatment to help determine whether the cancer treatment is working.