Investigations for gynaecological cancer
Investigations are likely to include a combination of the following:
- Pelvic examination in the gynaecological oncology clinic
- Blood tests
- Ultrasound scan
- Computerised Tomography (CT) scan
- Magnetic Resonance Imaging (MRI) scan
- Examination under anaesthetic (EUA)
- Ultrasound guided biopsy
An ultrasound scan is a procedure that uses high frequency sound waves to create an image of part of the inside of the body, such as the womb (uterus). Ultrasound scans are commonly used during pregnancy. They can be external or internal.
If you have an external scan, a small hand held device called a transducer is placed onto your skin and moved over the part of your body being examined. It is linked to a computer and images are shown on a computer screen. If you have an internal scan, a slim transducer probe is placed into your vagina and images are shown on a computer screen. Internal scans may cause some discomfort but don’t usually cause any pain and shouldn’t take very long.
A CT scan takes a series of x-rays of your body from different angles. It is also known as a CAT scan, which stands for computerised axial tomography.
The CT scanner is large and looks like a thick ring. You will usually lie on your back on a couch. The couch can slide backwards and forwards through the hole of the ring. The x-rays are taken as you move through the machine. Unlike an MRI scan where you are placed inside a tunnel, you should not feel claustrophobic. The scan takes 10-30 minutes and is painless. You may be given a drink or injection of a dye (through a vein in your hand or forearm) which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. You will usually be able to go home as soon as the scan is over. You may find this video on Youtube about having a CT scan helpful. It is produced by MacMillan Cancer Support.
An MRI scan is a type of scan that uses strong magnetic fields and radio waves to produce detailed images of the inside of the body.
The MRI scanner is like a tunnel surrounded by a large circular magnet. You lie on a couch which then slides into the scanner. You have to lie as still as you can, but breathe normally. The radiographer will offer you ear plugs or headphones to wear as the scanner is very noisy. The noise is like a loud clanging inside the tunnel and it goes on throughout the scan. The scan takes about 20 minutes and is painless. Some people feel a bit claustrophobic (closed in) when they are having a scan. If you feel that you are likely to feel this way then tell the radiographers before the day of your scan as they may be able to organise a sedative for you to take. You may be given an injection of a dye, through a vein in your hand or forearm, which allows particular areas to be seen more clearly. You may find this video on Youtube about having an MRI scan helpful. It was produced by Cancer Research UK.
Hysteroscopy is a procedure to examine the inside of your womb (uterus). It is carried out using a hysteroscope, which is a narrow tube with a telescope at the end. Images are sent to a computer in order to get a close up of the womb. You can watch on screen if you wish. It is similar to having a smear test, but takes a little longer (10 - 30 minutes). It is carried out by a specialist called a hysteroscopist who can be a doctor or a specially trained nurse. You may have some mild discomfort, similar to period pain, but this should settle after a few hours
Hysteroscopies are often carried out in the out-patient department while you are awake. The procedure may be performed under general anaesthetic (when you are asleep), as a day case operation, depending on your circumstances.
Colposcopy is a procedure to find out whether there are abnormal cells on your cervix (neck of the womb). It is usually carried out if you have had an abnormal smear. A microscope (colposcope) with a strong light is used to look at the cervix. The colposcope doesn’t enter the vagina and remains outside the body. Different liquids are dabbed onto the cervix to help identify any areas of abnormal cells. If an abnormal area is found then a small sample of tissue (biopsy) will be taken from the surface of the cervix. A biopsy is about the size of a pinhead. You may feel a slight stinging, but it should not be painful.
The procedure is usually carried out in the out-patient department, while you are awake, by a specialist called a colposcopist. This can be a doctor or a specially trained nurse.
An EUA is an examination of your vagina and cervix, when you are asleep under a general anaesthetic. It allows you to be examined without it being too uncomfortable. The doctor may also look in your bladder with a cystoscope, which is a narrow tube with a telescope at the end. This is called a cystoscopy. Biopsies may be taken from your cervix, vagina or bladder.
EUA’s are carried out in an operating theatre and you can usually go home the same day.
This investigation involves inserting a needle through your skin to take away a small amount of tissue (biopsy). It is carried out by a radiologist (X-ray doctor) in the radiology department using an ultrasound machine.
You will be asked to lie down on an ultrasound bed. The radiologist will choose the place for the biopsy with the ultrasound probe. The skin will be cleaned and then numbed with local anaesthetic. A thin needle will be placed through the skin into the place needing biopsy. The ultrasound machine is used to ensure the needle is in the right place. A small sample will then be taken. You will usually go back to the gynaecology ward to recover and may be able to go home a few hours later.