Uterine Sarcoma: Diagnosis

What tests and exams might I need?

You may have 1 or more of these tests and exams: 

• Pap test

• Pelvic exam

• Transvaginal ultrasound

• Endometrial biopsy

• Dilation and curettage (D&C)

• Hysteroscopy

Pap test

This is a common test you may have had before as part of a routine checkup. A tool called a speculum is put into your vagina to hold it open. It may feel a little uncomfortable, but it shouldn't hurt. This allows your healthcare provider to see the top part of your vagina and the opening of your uterus (cervix). A small spatula or brush is used to take some cells from the cervix and upper vagina. These cells, called a sample, are then sent to a lab where they are tested to check for cancer cells.

A Pap test does not check cells from deep inside the uterus, so it doesn't help diagnose uterine sarcoma. But it can help find out if your symptoms might be caused by something other than uterine cancer. 

Pelvic exam

A pelvic exam is done after the Pap test. The speculum isn't used for this test. Your healthcare provider will put lubricant on 1 or 2 gloved fingers and gently put them into your vagina. They will press on your belly (abdomen) with their other hand. This lets your provider check your uterus, ovaries, bladder, rectum, and vagina. They are feeling for lumps or anything else abnormal. 

Transvaginal ultrasound

An ultrasound uses sound waves to create images on a computer screen. A small wand, called a transducer, is lubricated and put into your vagina. Images then show up on a nearby screen. The transducer is gently moved around, and sound waves echo off your organs to create the images. This can help your healthcare provider see the thickness of the uterine lining and any tumors in the uterus or in the muscle wall of the uterus.

A saltwater solution may be put into the uterus. This expands it, which helps show the lining more clearly. This procedure is called a hysterosonogram or saline-infusion sonogram.   

Endometrial biopsy

The lining of the uterus is called the endometrium. A biopsy of the endometrial lining can show if you have cancer and, if so, the type of cancer. This procedure is a lot like getting a Pap smear. It's usually done outpatient in your healthcare provider’s office. Like the Pap smear, a speculum is used to hold your vagina open. Then your provider puts a thin tube through your vagina and cervix into your uterus to take out a tiny bit of tissue by gently scraping or using gentle suction. The tissue is checked for cancer cells. If cancer is found, tests will be done to find out what type it is.  

Dilation and curettage (D&C)

A D&C is another kind of biopsy. It's often done when larger amounts of tissue are needed for testing. It may be needed because an endometrial biopsy wasn't clear or didn't get enough tissue. It's often done in the hospital or surgical center.

You may be given general anesthesia to put you in a deep sleep during this test. Or you may be given a sedative plus local anesthesia to numb the area around your cervix. Your vagina is held open with a speculum. Then your cervix is opened (dilated) to let special tools pass through it into the uterus. Samples of the endometrium are taken out with these tools. The tissue is checked for cancer cells. If cancer is found, tests will be done to find out what type it is.  

Hysteroscopy 

This procedure can be used to take a biopsy of the endometrial tissue and look inside the uterus. The uterus is filled with saltwater to expand it. The cervix is opened (dilated) and a thin telescope-like tool and other small tools are then put through the cervix and into the uterus. Growths and changed areas are removed so they can be checked for cancer cells. 

Hysteroscopy may be done in your healthcare provider's office using numbing medicine. Or it may be done as an outpatient surgery, and you will be given medicines to make you sleep and not feel pain (general anesthesia). If cancer cells are found in the tissue that was removed, tests will be done to find out the type of cancer. 

Getting your test results

When your healthcare provider has your test results, they will talk with you about them and about next steps. You may want to ask how long it will take to get the results and how you'll get them. Will someone call you? Will you need an appointment to talk about them? You may be referred to a gynecologic oncologist. This is a doctor who treats cancers in the female reproductive organs. Make sure you understand your test results and what follow-up you need.