In most cases, the possibility of uterine sarcoma is suggested by certain symptoms. These symptoms do not always mean that a woman has a uterine sarcoma. In fact, they are more often caused by something else, such as non-cancerous changes in the uterus, pre-cancerous overgrowth of the endometrium, or endometrial carcinoma. Doctors use one or more tests to make a diagnosis.

Signs and symptoms of uterine sarcomas

Abnormal bleeding or spotting

If you have gone through menopause, any vaginal bleeding or spotting is abnormal, and it should be reported to your health care professional right away. About 85% of patients diagnosed with uterine sarcomas have irregular vaginal bleeding (between periods) or bleeding after menopause. This symptom is more often caused by something besides cancer, but it is important to have a medical evaluation of any irregular bleeding right away. Of the uterine sarcomas, leiomyosarcomas are less likely to cause abnormal bleeding than endometrial stromal sarcomas.

Vaginal discharge

About 10% of women with uterine sarcomas have a vaginal discharge (that does not contain any visible blood). A discharge is most often a sign of infection or another benign condition, but it also can be a sign of cancer. Any abnormal discharge should be investigated by your health care professional.

Pelvic pain and/or mass

When they are first diagnosed, about 10% of women with uterine sarcomas have pelvic pain and/or a mass (tumor) that can be felt. You or your doctor may be able to feel the mass in your uterus, or you may have a feeling of fullness in your pelvis.

Consultation, medical history, and physical exam

Consult with a specialist

If a uterine cancer is suspected, most doctors recommend that the woman be examined by a gynecologic oncologist (a doctor who specializes in diagnosing and treating female reproductive system cancers).

Complete medical history and physical exam

Your doctor will ask you about your personal and family medical history. You also will be asked about any symptoms, risk factors, and other health problems. You will be given a general physical and a pelvic exam.

Sampling and testing endometrial tissue

To find the cause of abnormal uterine bleeding, a sample of tissue will be removed from the lining of the uterus and looked at under a microscope. The tissue can be sampled by endometrial biopsy or by dilation and curettage (D&C). Often a hysteroscopy is done with the D&C.

These procedures let the doctor see if the bleeding is caused by benign endometrial overgrowth (hyperplasia), endometrial carcinoma, uterine sarcoma, or some other disease. The tests will find many endometrial stromal sarcomas, but less than half of leiomyosarcomas (LMSs). These tests don't find all LMSs because these cancers begin in the middle layer of the wall of the uterus. In order to be found by an endometrial biopsy or D&C, they need to have spread from the middle (muscle) layer to the inner lining of the uterus. Often it is only possible to diagnose a LMS by surgically removing it.

Endometrial biopsy

In this procedure, a very thin, flexible tube is inserted into the uterus through the cervix. Then, using suction, a small amount of endometrium is removed through the tube. Suctioning takes about a minute or less. The discomfort is similar to severe menstrual cramps and can be helped by taking a nonsteroidal anti-inflammatory drug such as ibuprofen an hour before starting. This procedure is usually done in the doctor's office.

Hysteroscopy

This is a procedure that allows doctors to look inside the uterus. A tiny telescope is inserted into the uterus through the cervix. To get a better view, the uterus is then expanded by filling it with salt water (saline). This lets the doctor see and biopsy anything abnormal, such as a cancer or a polyp. This procedure is usually done with the patient awake, using local anesthesia (numbing medicine). But if a polyp or mass has to be removed, general anesthesia is needed.

Dilation and curettage

If the results of the endometrial biopsy are not conclusive (meaning they can't tell for sure if cancer is present), a procedure called dilation and curettage (D&C) must be done. A D&C does not require admission to the hospital -- it is usually done in the outpatient surgery area of a clinic or hospital. This procedure is done while the woman is under general anesthesia or conscious sedation (medicine is given into a vein to make her drowsy) and takes about an hour. In a D&C, the cervix is dilated and a special surgical instrument is used to scrape tissue from inside the uterus. A hysteroscopy may be done as well. Most women have little discomfort after this procedure.

Testing endometrial tissue

Any tissue samples obtained by these procedures are looked at under the microscope to see if cancer is present. If cancer is found, the lab report will say if it is a carcinoma or sarcoma, what type it is, and what grade it is. A tumor's grade is based on how much it looks like normal tissue under the microscope. If the tumor looks a lot like normal tissue, it is called low grade. If it doesn't at all look like normal tissue, it is high grade. The rate at which the cancer cells appear to be growing is another important factor in grading a uterine sarcoma. High-grade sarcomas tend to grow and spread more quickly than low-grade sarcomas.

The tissue may also be tested to see if the cancer cells contain estrogen receptors and progesterone receptors. These hormone receptors are found on some endometrial stromal sarcomas. Cancers with these receptors on the cells are more likely to grow in response to the hormones estrogen and progesterone. These cancers may stop growing (or even shrink) when these hormones are blocked with certain drugs. Checking for these receptors helps predict which patients will benefit from treatment with hormone blocking drugs.

Cystoscopy and proctoscopy

If a woman has signs or symptoms that suggest the uterine sarcoma has spread to the bladder or rectum, the inside of these organs can be looked at through a lighted tube. These examinations are called cystoscopy and proctoscopy, respectively, but are rarely done in the diagnosis and work-up of patients with uterine sarcoma.

Imaging tests

Transvaginal ultrasound

Ultrasound tests use sound waves to take pictures of parts of the body. For a transvaginal ultrasound, a probe that gives off sound waves is inserted into the vagina. The sound waves are used to create images of the uterus and other pelvic organs. These images can often show any tumor that is present and whether or not it affects the myometrium (muscular layer of the uterus).

For an ultrahysterosonogram or saline infusion sonogram, salt water (saline) is placed into the uterus through a small tube before the transvaginal sonogram. This allows the doctor to see abnormalities of the uterine lining more clearly.

Computed tomography

The computed tomography scan (CT scan or CAT scan) is an x-ray procedure that produces detailed cross-sectional images of your body. For a CT scan, you lie on a table while x-rays are taken. Instead of taking one picture, like a regular x-ray, a CT scanner takes many pictures as the camera rotates around you. A computer then combines these pictures into an image of a slice of your body. The machine will take pictures of many slices of the part of your body that is being studied.

Before any pictures are taken, you may be asked to drink 1 to 2 pints of a liquid called oral contrast. This helps outline the intestine so that certain areas are not mistaken for tumors. You may also receive an IV (intravenous) line through which a different kind of contrast dye (IV contrast) is injected. This helps better outline structures in your body.

The injection can cause some flushing (redness and warm feeling that may last hours to days). A few people are allergic to the dye and get hives. Rarely, more serious reactions like trouble breathing and low blood pressure can occur. Medicine can be given to prevent and treat allergic reactions. Be sure to tell the doctor if you have ever had a reaction to any contrast material used for x-rays.

CT scans are rarely used to diagnose uterine cancer, but they may be helpful in seeing if the cancer has spread to other organs.

CT scans can also be used to guide a biopsy needle precisely into a suspected area of cancer spread. For this procedure, called a CT-guided needle biopsy, the patient remains on the CT scanning table, while a radiologist moves a biopsy needle toward the location of the mass. CT scans are repeated until the doctors are confident that the needle is within the mass. A fine needle biopsy sample (tiny fragment of tissue) or a core needle biopsy sample (a thin cylinder of tissue about one-half inch long and less than one-eighth inch in diameter) is removed and examined under a microscope.

CT scans take longer than regular x-rays and you need to lie still on a table in a ring while they are being done. But just like other computerized devices, they are getting faster and your stay might be pleasantly short. Also, you might feel a bit confined staying still in the ring while the pictures are being taken.

Magnetic resonance imaging

Magnetic resonance imaging (MRI) scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases. A computer translates the pattern of radio waves given off by the tissues into a very detailed image of parts of the body. Not only does this produce cross-sectional slices of the body like a CT scanner, it can also produce slices that are parallel with the length of your body. A contrast material might be injected just as with CT scans but is used less often. MRI scans can help tell if a uterine tumor looks like cancer, but a biopsy is still needed to tell for sure. MRI scans are particularly helpful in looking for cancer that has spread to the brain and spinal cord.

MRI scans take longer than CT scans -- often up to an hour. You are placed inside a tube, which is confining and can upset people with claustrophobia. The machine also makes clicking or buzzing noises that some people may find disturbing. Most places provide headphones and music to block this sound.

Positron emission tomography scan

In the positron emission tomography (PET) scan, radioactive glucose (sugar) is injected into the patient's vein to look for cancer cells. Because cancers use glucose at a higher rate than normal tissues, the radioactivity will tend to concentrate in the cancer. A scanner can spot the radioactive deposits. This test can be helpful for spotting small collections of cancer cells. It may also help tell if a tumor is benign or malignant. PET scans are not yet routinely used for patients with a pelvic mass or abnormal bleeding.

Chest x-ray

A regular (plain) x-ray of the chest may be done to see if a uterine sarcoma has metastasized (spread) to the lungs and as part of the testing before surgery

Last Medical Review: 11/18/2009
Last Revised: 11/18/2009