If you’re having symptoms that might be caused by cancer in the uterus, such as unusual vaginal bleeding or pelvic pain, your doctor will want to get more information. Your doctor is likely to ask you questions about:
Your health history, including whether 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 whether you have gone through menopause
Your family history of cancer
Lifestyle habits, such as what you eat and how much physical activity you regularly get
In addition, your doctor may also do a physical exam.
Your doctor will place an instrument 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 your cervix--the opening of your uterus. 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. The Pap test does not check cells from deep inside the uterus. So it doesn't help diagnose uterine or endometrial cancer. But it can help your doctor find out if your symptoms might be caused by something other than uterine or endometrial cancer.
A pelvic exam is performed after the Pap test. Your doctor will apply lubricant and then insert a gloved finger or two into your vagina and use the other hand to press on your abdomen (belly). This lets the doctor check your uterus, ovaries, bladder, rectum, and vagina for lumps or anything else unusual that may not have been visible during the speculum portion of the exam.
An ultrasound using a probe inserted into your vagina can help doctors see the thickness of the uterine lining. Sometimes, fluid is inserted into the uterus to help show the lining more clearly. This procedure is called a sonohysterogram or saline-infused sonogram. You may notice cramping, spotting, or watery discharge after the procedure.
A biopsy of the endometrial lining is an accurate way to find out if you have uterine or endometrial cancer. This is done in a procedure that is similar to getting a Pap smear. It is usually done in your doctor’s office. In most cases, you will not need anesthesia. In some cases, your doctor may suggest a local anesthetic (numbing medicine). 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. The tissue is looked at under a microscope and checked for cancer. You may have spotting or bleeding for several days afterward.
A D&C is another kind of biopsy that is often used when larger amounts of tissue samples are needed for testing. 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, or dilated, to allow special instruments to be passed into the uterus. Using these tools, the doctor will take samples of the endometrium, which is the lining of the uterus. You may notice cramps and bleeding after a D&C. A pathologist looks at the cells under a microscope to see if there is any cancer.
Hysteroscopy is a surgical procedure that allows doctors to take a biopsy of the endometrial tissue and also look inside the uterus. A thin telescope-like instrument and other small tools are inserted through the cervix and into the uterus. Hysteroscopy may be done in your doctor's office with a sedative, or as an outpatient surgery with general anesthesia.
Your doctor makes decisions about your diagnosis based on the results of these tests. Your doctor may decide any of the following:
You probably don’t have cancer.
You need more tests to decide whether or not you have cancer. One type of uterine sarcoma, for example, often does not show up in a biopsy.
You don’t have cancer, but you have changes inside your uterus that might turn into cancer in the future.
You have cancer.
You may need other tests to find out the type of uterine cancer you have--uterine sarcoma or endometrial cancer. If cancer is diagnosed, most (but not all) patients will need surgery.