How Is Uterine Sarcoma Diagnosed?

Many uterine sarcomas are diagnosed during or after surgery for what's thought to be benign fibroid tumors.

Some are diagnosed because of symptoms. If you have symptoms of uterine cancer, the first step is to see your doctor.

Consultation, medical history, and physical exam

Your doctor will ask you about your personal and family medical history, examine you, and might order some tests. You also will be asked about any symptoms, risk factors, and other health problems. A general physical and a pelvic exam will be done. An ultrasound may be used to look at the inside of your uterus.

 If your doctor suspects cancer, you may be referred to a gynecologist or a doctor specializing in cancers of the female reproductive system (called a gynecologic oncologist).

Sampling and testing endometrial tissue

To find the cause of abnormal uterine bleeding, a small piece of tissue (a sample) will be taken from the lining of the uterus and looked at with a microscope. The tissue can be removed 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 a endometrial overgrowth that's not cancer (hyperplasia), endometrial carcinoma, uterine sarcoma, or some other problem. The tests will find many endometrial stromal sarcomas and undifferentiated sarcomas, but less than half of leiomyosarcomas (abbreviated LMSs). These tests don't find all LMSs because these cancers start in the muscle layer of the wall of the uterus. 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. In most cases, the only way to diagnose a LMS by removing it with surgery.

Endometrial biopsy

In this procedure, a very thin, flexible tube is put into the uterus through the cervix. Then, using suction, a small amount of the uterine lining (endometrium) is taken out through the tube. Suctioning takes about a minute or less. The discomfort is a lot like severe menstrual cramps and can be helped by taking a nonsteroidal anti-inflammatory drug like ibuprofen an hour before the biopsy. This procedure is usually done in the doctor's office.

Hysteroscopy

This procedure allows doctors to look inside the uterus. A tiny telescope is put 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 take out 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 or regional anesthesia is sometimes used. (General anesthesia means you are given drugs that put you into a deep sleep and keep you from feeling pain. Regional anesthesia is a nerve block that numbs a larger area of the body).

Dilation and curettage

If the results of the endometrial biopsy are not clear (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 is usually done in the outpatient surgery area of a clinic or hospital. It's done while the woman is under general or regional anesthesia or conscious sedation (medicine is given into a vein to make her drowsy). It takes about an hour. In a D&C, the cervix is dilated (opened) and a special surgical tool is used to scrape the endometrial tissue from inside the uterus. A hysteroscopy may be done as well. Some women have mild to moderate cramping and discomfort after this procedure.

Testing endometrial tissue

Any tissue samples taken out are looked at under a microscope to see if cancer is present. If cancer is found, the lab report will say if it's a carcinoma or sarcoma, what type it is, and its grade.

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's called low grade. If it doesn't at all look like normal tissue, it's 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 faster than low-grade sarcomas.

The tissue may also be tested to see if the cancer cells have estrogen receptors and progesterone receptors. These hormone receptors are found on many endometrial stromal sarcomas. Cancers with estrogen receptors on the cells are more likely to grow in response to estrogen, while those with progesterone receptors often have their growth decreased by progesterone. These cancers may stop growing (or even shrink) when treated with certain hormone drugs. Checking for these receptors helps predict which patients will benefit from treatment with these drugs.

Cystoscopy and proctoscopy

If a woman has signs or symptoms that suggest uterine sarcoma has spread to the bladder or rectum, the inside of these organs can be looked at through a lighted tube. These exams are called cystoscopy and proctoscopy, respectively. They 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 put into the vagina. The sound waves are used to create images of the uterus and other pelvic organs. These images can often show if there's a tumor and if it affects the myometrium (muscular layer of the uterus).

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

Computed tomography

The CT scan is an x-ray test that produces detailed cross-sectional images of your body. Instead of taking one picture, like a standard x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines these pictures into an image of a slice of your body.

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-guided needle biopsy: CT scans can also be used to guide a biopsy needle precisely into a suspected tumor. For this procedure, the patient remains on the CT scanning table while the doctor moves a biopsy needle through the skin and toward the tumor. CT scans are repeated until the needle is within the tumor. A fine needle biopsy sample or a larger core needle biopsy sample is then removed to be looked at with a microscope. This isn’t done to biopsy tumors in the uterus, but might be used to biopsy areas that look like metastasis (cancer spread).

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. 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 also very helpful in looking for cancer that has spread to the brain and spinal cord.

Positron emission tomography scan

In a PET scan, radioactive glucose (sugar) is injected into the patient's vein. Because many cancers use glucose much faster than normal tissues, the radioactivity tends to collect in the cancer. A scanner can then spot the radioactive deposits. This test can be helpful for spotting small collections of cancer cells that have spread beyond the uterus (matastasized).

Chest x-ray

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

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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Lee SW, Lee TS, Hong DG, et al. Practice guidelines for management of uterine corpus cancer in Korea: a Korean Society of Gynecologic Oncology Consensus Statement. J Gynecol Oncol. 2017;28(1):e12.

Potikul C, Tangjitgamol S, Khunnarong J, et al. Uterine Sarcoma: Clinical Presentation, Treatment and Survival Outcomes in Thailand. Asian Pac J Cancer Prev. 2016;17(4):1759-1767.

Last Medical Review: October 12, 2017 Last Revised: November 13, 2017

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