How Does My Doctor Know I Have Uterine Sarcoma?
If you’re having 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
In addition, 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 to hold it open. It may feel a little uncomfortable, but it doesn’t hurt. With the vagina open in this way, the doctor can see the top part of your vagina and your cervix. Then your doctor will insert a gloved finger or 2 into your vagina and use the other hand to press on your abdomen. This lets him or her feel your uterus, ovaries, bladder, rectum, and vagina to 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 open with the speculum, your doctor inserts a small wooden 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 is to look for precancerous or cancerous changes on the cervix (tip of the uterus) and is not designed to check for uterine cancers. In some cases, abnormal cells are present on the Pap smear which may be explained by cancer in the uterus, fallopian tubes, or ovaries.
Endometrial Biopsy
A biopsy is one way to find out if you have uterine sarcoma. 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. If you need general anesthesia so that you will be asleep, then the biopsy is done in a hospital or an outpatient surgery center. You put your feet in stirrups. Your doctor uses a tool called 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.
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 may 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. Your doctor 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 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.
I’ve Just Been Told I Have Uterine Sarcoma
There are very few things scarier than being told you have cancer. You may feel like you’re in shock. You may not even want to believe what the doctor has told you. And there are probably so many questions you want to ask but think you can’t because you don’t know where to start.
First of all, it’s OK to be overwhelmed. And it’s OK to feel afraid. But you shouldn’t let those feelings stop you from finding out as much as you can about your cancer and about the options you have. Because the more you know, the less helpless and afraid you will feel. And the more you know, the better you will be able to work with your healthcare team to make the best choices for your treatment.
This section has one purpose. It’s here to help you start learning the things you need to know to be able to face your cancer experience with confidence. And the best way to start is to learn more about your uterus, how uterine sarcoma develops, and your diagnosis.
To recommend the best treatment for you, your healthcare team needs to know as much as they can about you and your cancer. As there are several different types of uterine sarcoma, the biopsy may suggest a particular type. Your doctor can explain how the particular type of uterine sarcoma is best treated. Sometimes x-ray tests are performed (like a chest x-ray or CT scan) to look for spread of cancer outside of the uterus.
The usual treatment for uterine sarcoma is a surgery to remove the uterus (hysterectomy). In addition, doctors often recommend removal of lymph nodes in the pelvis and abdomen for some types of uterine sarcomas. It often takes 1-2 weeks to have tests and to arrange and coordinate the surgery. This gives you time to get all the details your doctor needs. You also have time to talk with your doctor about treatment choices. You can get a second opinion, decide about treatment, and prepare yourself and your loved ones. Surgery removes the effected organ (uterus) and can also help to determine if the cancer has spread as well. Following surgery you may need other tests so that your doctor can learn more about the stage and how the cancer might respond to various treatments.
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 you have your uterus removed. If so, samples taken from your uterus after it is removed help your doctor decide whether you need more treatment.
In addition, your doctor may request tests to learn more about your type of uterine cancer, its location, and whether it has spread. Here are some of the tests you may have. You’ll likely have these same tests whether you have endometrial cancer or uterine sarcoma, though what the doctor looks for may be different.
Transvaginal Ultrasound
High-frequency sound waves bounce off internal body parts to create an image of your pelvic area. These images help your doctor see if there are growths in the lining of your uterus, if there are masses in the uterus, or if the ovaries are enlarged. An ultrasound also provides measurements of the uterine size. To perform an ultrasound you be asked to lie on your back on an examination table. Your doctor inserts a thin, long probe into your vagina that is similar in size to a speculum used to collect a Pap smear. 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.
Magnetic Resonance Imaging (MRI)
MRIs use radio waves and magnetic fields to create images of your body. In some cases, it is important to know about the depth the cancer extends into the uterine wall, if there is spread to the cervix (tip of the uterus), or if there is spread to the lymph nodes before surgery is performed. Doctors also can use MRI scans to help decide whether or not a tumor is cancerous (for example, evaluating a suspected fibroid). Your doctor will explain why or why not an MRI is needed. For this test, you lie still on a table as it passes through a tubelike 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 2 to 15 minutes, so the whole scan may take an hour or more. This test is painless and noninvasive. Ask for earplugs if they aren’t offered, since there is a loud thumping noise during the scan. If you’re claustrophobic, you may be given a sedative before having this test.
CT Scan
In some cases, a CT scan can help determine if cancer has spread outside of the uterus. It may also be used to help follow patients after their initial treatment to make sure the cancer has not come back (recurred). During a CT scan, X-rays scan the abdomen and pelvis, typically taking about 30 min. These special X-rays are more sensitive than a typical X-ray. To have the test, you will need to drink a solution (oral contrast) that passes through your intestines, and in most cases, receive an injection of a medicine (IV contrast dye) that helps with evaluating normal from not normal tissues. You lie still on a table as it gradually slides through the center of the CT scanner. Then the scanner rotates around you, directing beams of X-rays at your abdomen and pelvis. A computer uses the data from the X-rays to create many pictures of your abdomen and pelvis, which can be used together to create a three-dimensional picture. A CT scan is painless and noninvasive. You may be asked to hold your breath one or more times during the scan. Some patients experience nausea or diarrhea after the oral contrast solution. Some patients have an allergy to the injection contrast (iodine allergy), and the contrast can cause some patients kidney injury with its use. Your doctor and the radiologist will determine and explain what is recommended and why.
Chest X-ray
A chest X-ray is commonly performed is patients who are scheduled for surgery. It may be used to evaluate for heart or lung problems, and can show if the cancer has spread to your lungs. The procedure is quick and painless.
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.
Other tests are infrequently ordered, but include:
Cystoscopy
This test checks to see if cancer has spread to your urethra or bladder. Here’s how it’s done. You have this 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 a 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 tube 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. The whole test takes between 5 and 20 minutes. 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.
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)
PET can show where cancerous cells occur throughout the body. A special glucose dye injected into your vein helps highlight these cells. Researchers are studying whether PET can help determine which tumors are cancerous and which are not.
