When a woman experiences symptoms that may be caused by a gynecological cancer—such as unusual vaginal bleeding, pain or bloating—her doctor may recommend imaging tests to look for tumors in or around her reproductive organs.
Those tests are performed by radiologists, who are specially trained physicians. Often times, magnetic resonance imaging (MRI), computerized tomography (CT), ultrasound and positron emission tomography (PET) is utilized.
At Yale Medicine, radiation oncologists in the Department of Radiology & Biomedical Imaging are an important part of a patient’s care team throughout diagnosis, treatment and recovery. We work closely with gynecologists and oncologists to ensure you receive care quickly and comprehensively.
What happens before an imaging test?
Imaging tests for gynecologic cancers are usually done on an outpatient basis, so you do not have to stay overnight at the hospital. Before you undergo an imaging exam, you may be screened for allergies to contrast dye or for conditions, including diabetes, kidney disease or pregnancy.
However, that may complicate the screening process. Depending on the test, you may be asked not to eat or drink the night before or the day of the procedure. A radiologist will explain the procedure and answer any questions.
“I try to make sure patients understand the length of the examination, its pros and cons and that not only do we do our best to accommodate them but that they are always monitored by professional staff while they are being scanned,” says Gary Israel, MD, a Yale Medicine radiologist.
What imaging tests are used to diagnose gynecological cancers?
Depending on your symptoms, risk factors and medical history, a doctor may recommend one or more of the following tests. A CT scan for gynecological cancers usually includes the chest, abdomen and pelvis. This test uses high-resolution X-rays to create cross-sectional pictures of internal organs and tissues.
About 40 minutes before the procedure, you may have to drink an oral contrast liquid, which helps certain organs show up more clearly on X-ray images. The test should take from 10 to 30 minutes.
You lie still on a narrow table that slides back and forth while thin X-ray beams rotate all the way around the body. An MRI of the pelvis (and sometimes the abdomen) is another way doctors diagnose and monitor gynecological tumors.
Because this test uses high-powered magnets, you should tell your doctor if you have any metal implants in her body, and should remove any clothes or accessories that contain metal. This test usually takes from 30 to 60 minutes.
The table slides into a long, cylindrical scanner. The machine will make loud banging and whirring noises as it scans the body, using a magnetic field to map out and construct images of the body’s internal structures.
A positron emission tomography (PET) scan is sometimes used to diagnose or monitor cervical cancer, or to see whether cancer has spread to other parts of the body. For this test, a small amount of radioactive glucose—called a tracer—is injected into your vein. It takes about an hour for the tracer to be fully absorbed by the body.
The scan then takes about 20 to 30 minutes. You lie on a sliding table while a scanner rotates around your body. Because tumor cells are more active and use more glucose than normal cells, the tracer goes to those areas, and they show up brighter in the images collected by the scanner.
An ultrasound is often a first step in diagnosing ovarian and endometrial cancers, but follow-up tests are usually needed. While, it's faster, it cannot distinguish between cancerous and benign tumors.
Sometimes the ultrasound probe is rubbed against the skin when monitoring a pregnant woman’s stomach. Other times, the probe is inserted vaginally to get a better look at the reproductive organs and tissues. For either type of ultrasound, the exam will take about 20 to 30 minutes.
What are the risks of imaging tests for gynecologic cancers?
Imaging tests are quick and noninvasive ways for doctors to determine whether cancer is present or see whether it has spread. CT scans do expose patients to radiation at a much higher dose than regular X-rays.
The danger posed by a single CT scan is extremely small, but because excess radiation is a risk factor for future cancers, CT scans should not be performed unless there is a clear benefit to the patient.
Patients are also exposed to radiation during a PET scan, but at a much lower dose. (The tracer is only radioactive for a few hours.) Ultrasounds and MRI scans do not involve any radiation at all.
There is also a small risk of allergic reaction to a contrast dye or, for a PET scan, to the tracer material. Women who are pregnant or breastfeeding should talk to their doctor about how an imaging scan might affect them or their fetus.
What happens after the test?
After imaging tests are performed, a radiologist interprets the images and writes a report that is sent to the referring doctor. If your images show or suggest that cancer is present, more tests—such as a biopsy—may be needed to determine the type and stage of the disease.
Those results inform the patient’s treatment plan, which may involve surgery, radiation or chemotherapy. Imaging is also very important during and after a patient’s treatment.
Imaging can show whether cancer is shrinking as a result of chemotherapy or radiation and whether surgery was successful in removing an entire tumor. Even after you are in remission, follow-up scans every few months or years may be recommended to make sure cancer does not come back.
What's distinctive about Yale Medicine's approach?
“Once the imaging interpretation is done, Yale Medicine physicians' reports are available in the electronic medical record shortly afterward,” Dr. Israel says. “This system allows easy communication about the findings and the need for urgent or emergent attention to the clinicians.”
Radiologists at Yale Medicine work closely with gynecologists and oncologists to ensure you receive care quickly and comprehensively.
“Once the imaging interpretation is done, reports are available in the electronic medical record shortly afterward,” Dr. Israel says. "Yale Medicine also has a system to communicate findings that need immediate attention to the clinicians.”