Tests
If you have a condition or symptom but don’t yet know the cause, your doctor may order tests to gather more information. Common tests include biopsy and state-of-the-art imaging. Once your tests are complete, you and your doctor discuss the results, confirm your diagnosis and decide on next steps.
You may have one or more of these tests to help your doctor confirm diagnosis:
- Biopsy: A biopsy is the removal of tissue from areas of the body that appear suspicious or abnormal. In gynecology, there are several types of biopsy:
- Colposcopic biopsy is the removal of a small piece of tissue from the surface of the cervix to test for cervical cancer.
- Endocervical scraping involves scraping of endocervical tissue using a narrow instrument called a curette or a brush.
- Cone biopsy, also known as conization, involves removing a cone-shaped piece of tissue. The sample includes tissue from the exocervix, the endocervical canal, and the transformation zone (the border between the exocervix and endocervix, where cervical pre-cancers and cancers are most likely to start).
- Endometrial biopsy is the removal of a small sample of endometrial tissue using a suction tube.
- Colposcopy: Similar to a pelvic exam, your doctor examines the cervix with a colposcope. The colposcope is an instrument that stays outside the body. It has magnifying lenses that let the doctor clearly see the surface of the cervix up close. A weak solution of acetic acid is applied to the cervix to make abnormal areas easier to see. If an abnormal area is seen, a biopsy (removal of a small piece of tissue) is done.
- Dilation and curettage (D&C): In this procedure, the opening of the cervix is enlarged (dilated) and a special instrument is used to scrape tissue from inside the uterus. The tissue is then examined to see if cancer cells are present.
- Hysteroscopy: This procedure involves filling the uterus with saline and inserting a tiny telescope into the uterus through the vagina and cervix. This process allows a doctor to look for and biopsy anything abnormal, such as a cancer or a polyp.
- Imaging studies: For many gynecologic cancers, radiological imaging is good at finding abnormal areas. We review any prior X-rays, CT scans, PET scans, MRIs, ultrasounds or other scans you have received. You may be asked to undergo more imaging. Some tumors can be identified successfully based on their imaging characteristics, and others cannot.
- Medical history: We review your medical history to look for clues that might show what type of lesion or tumor you have and what caused it.
- Pap smear: This is a cervical cancer screening test that involves swabbing of cells in the cervix to look for abnormalities.
- Physical exam: Physical examination can sometimes provide additional information about the origin of your tumor or lesion.
- Ultrasound: This common test is used to look at the uterus, ovaries, and fallopian tubes in women with possible gynecologic problems. Ultrasound uses sound waves and echoes translated by a computer into pictures of the inside of the body.
- Transvaginal ultrasound (TVUS) involves a camera probe inserted into the vagina to see if the uterus contains a mass or if the endometrium is thicker than usual, which can be a sign of endometrial cancer. TVUS may also help see if cancer is growing into the muscle layer of the uterus called the myometrium.
More information about diagnostic tests (American Cancer Society)
Treatments
There are many types of benign gynecologic conditions as well as types of gynecologic cancer. The gynecologic oncology program offers a range of treatments. You and your doctor discuss the best course of treatment for your condition, what you can expect for results, and what side effects you may experience.
Drug therapy
- Drug therapies involved delivering cancer-killing medicines into the body. Common types of drug therapy include:
- Chemotherapy, which uses anti-cancer drugs given intravenously to kill cancer cells that may be in your blood stream. Chemotherapy is sometimes used after surgery to reduce the chance of cancer returning in organs other than the primary site.
- Immunotherapy activates the patient’s own immune system to attack the tumor cells, by removing the blockade induced by the cancer.
- Targeted therapy (precision medicine), which uses drugs that affect specific molecules in the cancer cells that are important for the growth of the particular tumor. Comprehensive genomic analyses of the cancer are performed before selecting such treatment, so targeted therapy is individualized based on the composition of the tumor.
Surgery:
- Surgery may include removal of a cancerous mass or tumor or removal of the organ that has become cancerous. Surgery may also include removal of a few lymph nodes to detect whether cancer has spread. This procedure is called sentinel lymph node biopsy. Common types of gynecologic surgery include:
- Hysterectomy, which is surgery to remove the uterus and sometimes cervix (called a total hysterectomy). In a total hysterectomy with salpingo-oophorectomy, the uterus plus one or both ovaries and fallopian tubes are removed. In a radical hysterectomy, the uterus, cervix, both ovaries, both fallopian tubes, and nearby tissue are removed.
- Oophorectomy, which is surgery to remove one or both ovaries.
- Lymphadenectomy, which is surgery to remove lymph nodes and a sample of tissue to examine for signs of cancer.
- Cytoreductive surgery, which is surgery to remove any visible tumors in the abdomen.
We offer fertility-sparing surgery when possible and referrals to endocrinology for assisted reproductive technologies such as oocyte retrieval and embryo storage for women desiring future pregnancy. We work closely with the Comprehensive Wound Healing Center on ostomies and stomas.
Minimally invasive and robotic surgery
Our gynecologic oncologists take advantage of the latest technologies to provide minimally invasive and robotic options that are at the forefront of surgical care. We specialize in the use of these advanced options for diagnosis, staging and treatment of gynecologic malignancies to decrease pain, shorten recovery time and improve outcomes for patients, while advancing surgical practice in cancer treatment, particularly of late stage and complex disease.
Radiation therapy
New technologies are enabling radiation oncologists to use radiation therapy as an alternative to standard surgery. Our team offers state-of-the-art treatment plans for radiation therapy. Radiation treatment recommendations can often be coordinated with physicians and hospitals throughout New England.
Clinical trials
As a member of the Gynecologic Oncology Group (GOG), we offer new treatment being developed in clinical trials. GOG is a National Cancer Institute-sponsored organization promoting excellence in the quality and integrity of clinical and basic scientific research in the field of gynecologic malignancies.
Here are our active and enrolling gynecologic trials.
Your gynecologic oncologist meets with you to discuss your treatment options and potential side effects, and follows you and your progress throughout treatment. Whenever possible, we coordinate treatment through outreach centers closest to your home so you can minimize your travel during therapy.