How Does My Doctor Know I Have Uterine Cancer?
If you have symptoms that might be caused by cancer in the uterus, your doctor will want to check further. Your doctor is likely to ask you questions about these things:
- Your health history
- Your reproductive history, such as when you had your first period, 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
Your doctor may also do a physical exam. Here are some tests your doctor or a specialized nurse may do to check you.
Pelvic Exam
Your doctor places an instrument called a speculum into your vagina. The speculum holds it open. It may feel a little uncomfortable, but it doesn’t hurt. With the vagina open, the doctor can see the top part of your vagina and your cervix. Then your doctor will insert a gloved finger or two fingers into your vagina. The doctor will then use the other hand to press on your abdomen. This lets the doctor feel your uterus, ovaries, bladder, rectum, and vagina. As the doctor does, the doctor will check for lumps or anything else unusual.
Pap Test
Your doctor can do this test at the same time as the pelvic exam. While your vagina is held, your doctor inserts a small wooden spatula or brush. The doctor uses this 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. There the sample will be checked for precancerous or cancerous changes of the cervix—the tip of your uterus. The Pap test is not designed to evaluate cells from the lining surface (endometrium) of the uterus or ovaries. That means it is not a useful tool for detecting endometrial or ovarian cancer. Sometimes, however, abnormal cells from the uterus are picked up on Pap smear. If that happens, your doctor will recommend additional tests such as a biopsy to evaluate you further.
Endometrial Biopsy
A biopsy is one way to tell what is going on with the endometrium. Biopsies can provide information about the hormonal status/influence on the endometrium. The can also identify some infections and diagnose benign (non-cancerous) conditions like polyps. Polyps are small outgrowths of uterine tissue that sometimes cause spotting. Biopsies can also identify precancerous or cancerous conditions. A biopsy 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. If you need general anesthesia so that you will be asleep, then the biopsy is done in a hospital. Or it might be done in an outpatient surgery center. You put your feet in stirrups. Then your doctor uses a tool called a speculum to hold your vagina open. Your doctor inserts a thin tube through your vagina and cervix into your uterus. Your doctor does this to get a bit of tissue. The tissue is looked at under a microscope. When it is, it’s checked for cancer. You may have spotting or bleeding for several days afterward.
Dilation & Curettage (D&C)
A D&C is another kind of biopsy. It is usually done in the hospital or surgical center. Here’s how the procedure is done. You will get an anesthetic so that you are asleep and don’t feel pain. Or you may just be numbed in that area. Your vagina is held open with a tool called a speculum. Then, your cervix is opened wider (dilated) to allow instruments into the uterus. Some doctors also perform a hysteroscopy with the D&C. Using a special camera like instrument (hysterscope) that is passed into the uterine cavity, the doctor can see the lining surface of the uterus to direct biopsies. Your doctor then inserts a small instrument through your vagina and cervix into your uterus. This tool lets him or her scrape away 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.
What Your Doctor Learns From These Tests
Your doctor makes decisions about your diagnosis based on 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.
- You don’t have cancer, but you have changes inside your uterus that might turn into cancer in the future.
- You have cancer.
