Uterine cancer, also known as endometrial cancer, develops in the lining of the uterus and is one of the most common cancers affecting women. Detecting it early is essential, as early-stage diagnosis significantly improves treatment outcomes.
This article explains how uterine cancer is diagnosed — from symptom recognition to advanced imaging and biopsy tests.

Recognizing Early Symptoms

Uterine cancer often begins with noticeable warning signs. The most common symptom is abnormal vaginal bleeding, especially after menopause.
Other symptoms include:

  • Bleeding between periods

  • Watery or blood-tinged discharge

  • Pelvic pain or pressure

  • Pain during intercourse

  • Unexplained weight loss

These signs should never be ignored. Early medical evaluation allows doctors to detect uterine changes before cancer progresses.

Medical History and Physical Exam

Diagnosis starts with a comprehensive medical history and physical examination.
Your doctor will ask about:

  • Menstrual cycle changes

  • Pregnancy and fertility history

  • Hormone therapy or tamoxifen use

  • Family cancer history, especially uterine or colon cancer

The physical exam may include:

  • Abdominal and pelvic palpation

  • Inspection of the cervix and vaginal canal

  • A bimanual exam to assess uterine size or tenderness

These steps help determine whether additional diagnostic tests are needed.

Pelvic Examination

A pelvic exam allows the doctor to evaluate reproductive organs.
Using gloved hands, the physician feels the uterus, ovaries, and other pelvic tissues for abnormalities.
Although this test cannot confirm cancer, it provides crucial information that guides the next steps in diagnosis.

Transvaginal Ultrasound

The transvaginal ultrasound (TVUS) is often the first imaging test when uterine cancer is suspected.
A slender probe is inserted into the vagina to produce high-resolution images of the uterus.

TVUS helps measure:

  • The thickness of the endometrium (uterine lining)

  • The presence of masses or growths

  • Fluid or abnormalities within the uterine cavity

A thickened lining, especially in postmenopausal women, can signal cancer or precancerous changes. However, further testing is needed for confirmation.

Endometrial Biopsy

An endometrial biopsy is the gold standard for diagnosing uterine cancer. It involves collecting a tissue sample from the uterine lining for microscopic examination.

Procedure overview:

  1. A thin, flexible tube is inserted through the cervix.

  2. Suction is applied to obtain a small sample of tissue.

  3. The sample is sent to the lab for pathological review.

Pathologists look for abnormal or malignant cells. If cancer is present, they determine its type, grade, and extent.
This procedure is quick, minimally invasive, and often performed in-office.

Dilation and Curettage (D&C)

When biopsy results are inconclusive, doctors may perform a Dilation and Curettage (D&C) procedure.
It involves:

  • Opening the cervix

  • Scraping or suctioning tissue from the uterine lining using a curette

This method provides a more extensive tissue sample for accurate diagnosis.
D&C is usually done under mild anesthesia and may be combined with hysteroscopy for better visualization.

Hysteroscopy

During a hysteroscopy, doctors insert a thin, lighted tube through the cervix to look directly inside the uterus.

It allows:

  • Real-time visualization of the endometrium

  • Identification of growths, polyps, or irregular tissue

  • Immediate biopsy of suspicious areas

Hysteroscopy is a valuable diagnostic and sometimes therapeutic tool in uterine cancer detection.

Pap Test (Pap Smear)

The Pap test screens for cervical cancer, not uterine cancer — but it can occasionally detect abnormal endometrial cells.
If atypical glandular cells are found, your doctor may recommend further evaluation such as a biopsy or ultrasound.
Thus, while Pap smears don’t diagnose uterine cancer directly, they can serve as an early warning sign.

Imaging Tests

Imaging studies help doctors assess whether cancer has spread and to what extent. Common imaging tests include:

  • Ultrasound: Evaluates pelvic structures.

  • CT scan: Detects lymph node involvement or metastasis.

  • MRI: Shows the tumor’s depth and invasion into uterine muscle or adjacent organs.

  • PET scan: Identifies cancer spread to distant organs through metabolic activity.

These tests are essential for staging and treatment planning.

Blood Tests

No blood test alone can confirm uterine cancer, but they help assess overall health and detect complications.
Key blood tests include:

  • CA-125: May be elevated in some advanced cases.

  • Complete Blood Count (CBC): Detects anemia from chronic bleeding.

  • Liver and kidney panels: Evaluate organ function before treatment.

Blood tests complement imaging and biopsy results, giving a fuller picture of the patient’s condition.

Genetic Testing

If you have a strong family history of uterine, ovarian, or colon cancer, your doctor may recommend genetic testing.

This identifies mutations linked to hereditary syndromes like Lynch syndrome — involving genes MLH1, MSH2, MSH6, and PMS2.
A simple blood or saliva test can reveal whether you or your relatives are at increased risk, enabling preventive monitoring and early screening.

Staging the Cancer

Once cancer is diagnosed, it must be staged to determine its spread.
Doctors often use the FIGO (International Federation of Gynecology and Obstetrics) staging system:

  • Stage I: Confined to the uterus.

  • Stage II: Involves the cervix.

  • Stage III: Spread to nearby tissues or lymph nodes.

  • Stage IV: Spread to distant organs.

Accurate staging helps doctors design effective, individualized treatment plans.

Pathology Report and Tumor Grading

The pathology report from your biopsy or surgery contains vital information about your cancer.
It includes:

  • Cancer type: Most commonly endometrioid adenocarcinoma.

  • Tumor grade: Reflects how aggressive the cancer cells are.

    • Grade 1: Well-differentiated (less aggressive)

    • Grade 2: Moderately differentiated

    • Grade 3: Poorly differentiated (highly aggressive)

This grading helps predict how quickly the cancer may grow or spread and guides treatment decisions.

Differential Diagnosis

Several benign conditions can mimic uterine cancer symptoms. Doctors must rule out:

  • Endometrial hyperplasia

  • Uterine fibroids

  • Polyps

  • Hormonal imbalances

  • Atrophic endometritis

Careful evaluation ensures patients receive accurate diagnoses and appropriate treatment.

New Diagnostic Advances

Technological innovations have improved uterine cancer detection.
Recent advances include:

  • 3D transvaginal ultrasound for higher accuracy

  • Molecular testing to identify gene mutations

  • Targeted biopsy tools that minimize discomfort

These methods enhance diagnostic precision while reducing the need for invasive procedures.

Importance of Early Detection

When uterine cancer is caught early — before spreading beyond the uterus — the five-year survival rate can exceed 95%.
Delaying medical care for abnormal bleeding can allow the disease to progress silently.
Routine gynecologic checkups, awareness of body changes, and quick reporting of symptoms save lives.

When to See a Doctor

Seek immediate medical attention if you experience:

  • Postmenopausal bleeding

  • Bleeding between periods

  • Persistent pelvic pain or pressure

  • Unusual vaginal discharge

Even if these symptoms stem from benign causes, they should be properly evaluated to rule out cancer.

Questions to Ask Your Doctor

If you’re undergoing uterine cancer evaluation, ask:

  • What tests will I need, and what do they detect?

  • What stage is my cancer, if confirmed?

  • What are my treatment options?

  • Should I consider genetic testing for hereditary risk?

Being informed helps you take control of your care journey.

Emotional Support During Diagnosis

The diagnosis process can be stressful. Fear and anxiety are common, but emotional support can make a significant difference.
Consider:

  • Talking to a counselor or therapist

  • Joining uterine cancer support groups

  • Engaging in mindfulness or gentle physical activity

Addressing emotional health is just as important as treating the physical condition.

Follow-Up and Monitoring

After diagnosis or treatment, ongoing follow-up is critical.
Routine monitoring may include:

  • Pelvic exams every 3–6 months

  • Imaging scans for recurrence

  • Blood tests to assess overall recovery

Early detection of recurrence ensures timely intervention and improved long-term outcomes.

Conclusion

Diagnosing uterine cancer is a step-by-step process that begins with recognizing symptoms and continues through ultrasounds, biopsies, and imaging.
Each test plays a vital role in identifying the presence and extent of cancer, guiding doctors toward the most effective treatment.
With modern advancements and early detection, uterine cancer can often be successfully treated — giving women a strong chance at recovery and continued health.