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Early Detection, Diagnosis, and Staging of Uterine Sarcoma
Learn about the signs and symptoms of uterine sarcoma, the tests that are done to diagnose and stage the disease, and the outlook for people diagnosed with it.
Can uterine sarcoma be found early?
For some types of cancer, screening tests, or tests to find cancer in people without any symptoms, are recommended. However, at this time, there are no screening tests or exams to find uterine sarcomas in people without symptoms.
Seeing a healthcare professional right away if you have signs and symptoms of uterine sarcoma is the best way to find it.
Signs and symptoms of uterine sarcoma can include:
- Vaginal bleeding or spotting between menstrual cycles, after menopause, or prolonged periods
- Pelvic pain
- Lump in the abdomen (belly) or pelvis
In some cases, it can be found at an early stage, when it's small and hasn't spread. But many uterine sarcomas reach an advanced stage before signs and symptoms appear.
How is uterine sarcoma diagnosed?
Depending on the location or size of the tumor, diagnosing uterine sarcoma might involve physical exams, imaging, blood tests, and a biopsy or removal of a tumor.
Medical history and physical exam
Your healthcare team will take a complete medical history to find out more about your symptoms. They might ask if you have certain risk factors, like a family history of cancer.
The healthcare team will then examine you, looking for signs that point to a cause of your symptoms. During this physical exam, they might:
- Examine your abdomen (belly) to look or feel for a lump or area of pain
- Do a pelvic exam to check if the uterus is larger than normal
If there is a reason to suspect cancer based on your symptoms or exam, you might be told you need other tests to find out whether it is cancer or something else, such as a fibroid.
If you’re seeing your primary care team, you might be referred to a gynecologist or gynecologic oncologist, who is a doctor specializing in cancers of the female reproductive system.
Imaging tests
Imaging tests are used to create pictures of the inside of your body. Imaging can help your healthcare team:
- Find out if a suspicious area might be cancer
- Determine where a cancer started
- Learn how far cancer has spread
- Determine if treatment is working
- Look for signs that the cancer has come back after treatment
If you have a tumor in the uterus, or your healthcare team suspects you have one, you will get one or more of the following tests:
Ultrasounds use sound waves and their echoes to look inside the body.
For a transvaginal ultrasound, a probe that gives off sound waves is put into the vagina. The sound waves are used to make images of the uterus and other pelvic organs. These images can often show if there's a tumor or lump and if it invades the myometrium (muscle layer of the uterus).
For a sonohysterogram or saline infusion sonogram, salt water (saline) is put into the uterus through a small tube before or during the transvaginal ultrasound. This lets the doctor see changes in the uterine lining more clearly.
MRI scans create detailed images of soft tissues inside your body. This is done using radio waves and strong magnets instead of x-rays, so there is no radiation.
An MRI scan is the best test to tell if a uterine tumor looks like cancer, but a biopsy is still needed to tell for sure. It can also help find out whether any cancer has been left behind after surgery or if the cancer has grown into nearby structures, which can help in making a treatment plan.
MRI scans are also very helpful in looking for cancer that has spread to the brain and spinal cord.
The CT scan combines many x-ray pictures to make detailed, cross-sectional images of the soft tissues of your body.
CT scans are rarely used to diagnose uterine sarcoma, but they might be helpful in seeing if the cancer has spread to other organs.
CT-guided needle biopsy: For this procedure, you remain on the CT scanning table while the doctor moves a biopsy needle through the skin and toward an abnormal area or tumor to remove a biopsy sample. This isn’t done to biopsy tumors inside the uterus but might be used to biopsy areas that look like metastasis (cancer spread).
For a PET scan, a slightly radioactive form of sugar, known as FDG, is injected into the blood and collects mainly in cancer cells. These areas of radioactivity can be seen on a PET scan using a special camera.
A PET scan is useful to find out if the cancer has spread. PET and CT scans are most often done at the same time. This lets the doctor compare areas of higher radioactivity on the PET scan with a more detailed picture of that area on the CT scan.
Hysteroscopy
This procedure is a type of endoscopy that allows doctors to look inside the uterus. A thin, long camera called a hysteroscope is put into the uterus through the cervix.
To get a better view, the uterus is expanded by filling it with salt water (saline) or gas. Anything that looks abnormal, such as a cancer or polyp, can be removed. A biopsy can also be done during hysteroscopy.
Anesthesia provides pain relief. Different types may be used during a hysteroscopy:
- Local anesthesia, or numbing medicine
- Regional anesthesia, or a nerve block that numbs one area of the body
- General anesthesia, or drugs to put you in a deep sleep and prevent pain
If the doctor is just taking a look, this procedure can be done while you are awake, using local anesthesia. If a lot of tissue, a polyp, or a mass must be removed, general or regional anesthesia is used.
Cystoscopy and proctoscopy
These procedures are types of endoscopy that might be done if someone has signs or symptoms that suggest uterine sarcoma has spread to the bladder or rectum. Cystoscopy (to look in the bladder) and proctoscopy (to look in the rectum) might be used if other imaging tests don’t show the area well as part of uterine sarcoma staging. These procedures involve a camera or lighted tube to look inside these organs.
Biopsy
A biopsy is a small sample of tissue. Looking at a biopsy sample under a microscope is often the only way to find out for sure whether an abnormal area is cancer or another condition.
In some cases, surgery to completely remove an abnormal area might be used to make a diagnosis instead of a biopsy.
A small piece of tissue will be taken from the endometrium (lining of the uterus) and examined in the lab.
In this office procedure, a thin, flexible tube is put into the uterus through the vaginal opening and cervix. Then, using suction, a small sample of the endometrium is taken out through the tube. Suctioning takes about a minute or less and might be done more than once to get enough tissue.
The discomfort is a lot like severe menstrual cramps and can be helped by taking a nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen an hour before the biopsy, if approved by your doctor.
In a D&C, the cervix is dilated (opened), and a special surgical tool is used to remove the endometrial tissue. It is a surgical procedure that is usually done in the outpatient surgery area of a clinic or hospital.
It is usually done if an endometrial biopsy is not possible or the results of the endometrial biopsy are not clear.
It's done under general or regional anesthesia or conscious sedation, where medicine is given into a vein to make you drowsy. Some people have mild-to-moderate cramping and discomfort after this procedure.
If a mass is protruding from the cervix, doctors might biopsy or remove the tumor through the vaginal opening.
If a mass looks suspicious for cancer on imaging tests, such as an MRI, your cancer care team might recommend a biopsy using a thin, hollow needle through the skin.
Ultrasound or CT scans can help guide the needle into the mass to collect a sample.
Lab tests
All biopsy samples are sent to the lab to be looked at under a microscope by a pathologist, a doctor specializing in diagnosing and classifying diseases. If cancer is found, the lab report will say whether it's a carcinoma or sarcoma, what type it is, and its grade.
For certain uterine sarcomas, molecular tests to look for certain proteins or gene changes might be done to help confirm a diagnosis or help your cancer care team find targeted therapy options that might work.
IHC tests aim to identify specific features of cells. This is done by processing a biopsy sample in such a way that a color change is visible if the feature exists.
For uterine sarcoma, this might be done to identify whether the cells have hormone receptors, which might help guide treatment options.
For this test, cancer cells are grown in a lab dish, and the chromosomes (bundles of DNA) are looked at under a microscope. Doctors look at the number and structure of the chromosomes to find any changes.
This is another way to look at chromosomes and genes. It uses special dyes that only attach to specific parts of certain chromosomes. FISH can be used to look for specific changes in chromosomes. It is very accurate and can usually provide results within a couple of days.
PCR is a very sensitive test that can find chromosome and gene changes too small to be seen under a microscope, even if there are only a few tumor cells in the sample.
This test might also be used to look for gene changes in cancer cells that might not be seen on routine cytogenetic tests. NGS can sometimes tell doctors more about the best treatments for a person and their prognosis (outlook).
Staging and outlook for uterine sarcoma
After a uterine sarcoma diagnosis, many people want to know what to expect. Your cancer care team uses information about a tumor’s stage (extent) to decide what treatment is best for each person.
Survival rates are a way to measure how many people survive a certain type of cancer over time. Some people find this information helpful, while others prefer to focus more on treatment plans and next steps.
Questions to ask if you have uterine sarcoma
Understanding your diagnosis
- How sure are you that my tumor is uterine sarcoma?
- Where is the cancer located? How big is it?
- How likely is this tumor to grow or spread quickly?
- Has my tumor spread outside the uterus?
- What is my cancer's stage, and what does that mean?
- What else do you know about my cancer based on the tests you’ve done?
- Will I need any other tests before we can decide on treatment?
- What is my prognosis (outlook), based on what you know about my cancer?
Talking about treatment
- Do I need to see any other doctors or health professionals?
- Who else will be on my treatment team, and what will they do?
- Are there any clinical trials we should consider? How can we find out more about them?
- Should I get a second opinion? How do I do that? Can you recommend a doctor or cancer center?
- If I'm concerned about costs and insurance coverage for my diagnosis and treatment, who can help me?
- Written by
- References
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
Gaillard S, Secord A. Endometrial stromal sarcomas, related tumors, and uterine adenosarcoma. UpToDate. 2026. Accessed at https://www.uptodate.com/contents/endometrial-stromal-sarcomas-related-tumors-and-uterine-adenosarcoma on February 17, 2026.
Memarzadeh S, Berek J. Uterine sarcoma: Classification, epidemiology, clinical mainfestations, and diagnosis. UpToDate. 2026. Accessed at https://www.uptodate.com/contents/uterine-sarcoma-classification-epidemiology-clinical-manifestations-and-diagnosis on February 17, 2026.
National Cancer Institute. Uterine Sarcoma Treatment. Accessed at https://www.cancer.gov/types/uterine/hp/uterine-sarcoma-treatment-pdq on February 17, 2026.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Uterine Neoplasms Version 2.2026 – November 14, 2025. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf on February 17, 2026.
Petrocelli R, Hindman N, Reinhold C. Current Concepts in the Imaging of Uterine Sarcomas. Radiol Clin North Am. 2023;61(4):627-638.
Raffone A, Raimondo D, Neola D, et al. Diagnostic accuracy of MRI in the differential diagnosis between uterine leiomyomas and sarcomas: A systematic review and meta-analysis. Int J Gynaecol Obstet. 2024;165(1):22-33.
Last Revised: June 9, 2026
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