Diagnosis of cervical cancer

Diagnosis is the process of finding out the cause of a health problem. Diagnosing cancer often means first ruling out other health conditions that share similar symptoms with cancer. It can be a very worrying time for you and your loved ones. Sometimes this process is quick. Sometimes it can feel long and frustrating. But it’s important for doctors to get all the information they need before making a diagnosis of cancer.

Usually, diagnosing cervical cancer begins when a Pap test suggests a problem with the cervix. Your doctor will ask you about any symptoms you have and may do a physical exam. Based on this information, your doctor will refer you to a specialist or order tests to check for cervical cancer or other health problems.

The following tests are usually used to rule out or diagnose cervical cancer. Many of the tests that are used to diagnose cancer are also used to find out the stage (how far the cancer has spread). Your doctor may also order other tests to check your general health and to help plan your treatment.

Your health history is a record of your symptoms and risks and all the medical events and health problems you have had in the past. Your doctor will ask questions about your history of:

• symptoms that suggest cervical cancer
• sexual activity
• abnormal Pap test results
• smoking

A physical exam allows your doctor to look for any signs of cervical cancer. During a physical exam, your doctor may:

• do a Pap test and a pelvic exam
• do a digital rectal exam (DRE) to feel for any abnormal changes
• feel the lymph nodes in the groin and above the collarbone to see if they are swollen

Find out more about a physical exam, a pelvic exam and a digital rectal exam (DRE).

A Pap test is a procedure that removes a small sample of cells from the cervix. It is done to look for changes to the cells in the cervix. Doctors look at the cells under a microscope to see if they look normal or abnormal. The test can find abnormal changes in cells early, before cancer develops.

A Pap test is used to screen for cervical cancer. It is done every 3 years. If you are at a higher than average risk, you may need a personal plan for testing. This may include more frequent screening for cervical cancer.

Find out more about a Pap test.

A human papillomavirus (HPV) test is a lab test that looks for the DNA of high-risk types of HPV that have been linked to cervical cancer. In some cases, the HPV test can be done on the sample of cells collected during a Pap test.

An HPV test is used to screen for cervical cancer because most types of cervical cancer are linked to HPV. The test is done every 5 years. An HPV test can be done at home or with a healthcare provider, and both are effective ways to screen for cervical cancer. Choose whichever option is available and comfortable for you.

Find out more about an HPV test.

A colposcopy uses a lighted magnifying instrument to examine the vulva, vagina and cervix. This instrument is called a colposcope.

A colposcopy is done after an abnormal Pap test or a positive HPV test suggests a precancerous condition of the cervix or cervical cancer. A colposcopy may also be done if you have symptoms of cervical cancer.

A colposcopy is done in a similar way to a Pap test. The doctor places a speculum in the vagina. The speculum is a plastic or metal device that separates the walls of the vagina so the doctor can clearly see the cervix. The doctor may swab the area with a solution that helps the lining of the cervix show up better. The doctor then uses a colposcope to carefully examine the inside surface of the cervix and the vagina. The colposcope is positioned outside the opening of the vagina, rather than inserted into the vagina. The doctor may do a biopsy during a colposcopy if there is an abnormal area on the cervix.

It is better to have a colposcopy when you aren’t menstruating. For 48 hours before the test, avoid the following (except as directed by your doctor) because they can interfere with the procedure and affect the test results:

• sexual intercourse
• vaginal douches (inserting a solution into the vagina and flushing it out)
• vaginal medicines
• contraceptive (spermicidal) creams, foams and gels

It’s possible to have a colposcopy while you are pregnant, but it might cause some bleeding if you are in your second or third trimester. If you are pregnant, talk to your doctor. It might be recommended that you wait until after delivery to have the colposcopy.

If your Pap test results are abnormal, your doctor will likely need to take a biopsy from the cervix. During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a lab. A report from a pathologist will show whether cancer cells are found in the sample.

The following biopsies may be used to sample cells and tissue from the cervix or nearby areas.

Find out more about a biopsy.

A colposcopic biopsy is done during a colposcopy. The doctor uses a surgical instrument called biopsy forceps to remove small amounts of tissue from suspicious-looking areas in the cervix or vagina.

An endocervical curettage is done during a colposcopy. A local anesthetic may be used to numb the cervix. The doctor uses a narrow, spoon-shaped tool called a curette to gently scrape cells and tissue from the endocervical canal.

An endometrial biopsy removes cells from the lining of the inside of the uterus (called the endometrium). These cells are removed using a special tool called a pipelle, and are then examined under a microscope to check for cancer. An endometrial biopsy can be done during a colposcopy.

A cone biopsy removes a cone-shaped piece of tissue from the cervix. The cone is formed by removing the outer part of the cervix closest to the vagina and part of the endocervical canal.

Depending on the way the cone biopsy is done, it may be done during a colposcopy in a doctor’s office or as a separate procedure in an operating room. A cone biopsy may be the only treatment you need for a precancerous condition of the cervix.

You can still get pregnant if you have had a cone biopsy. If a large amount of tissue has been removed, you may have a higher risk of giving birth prematurely.

A loop electrosurgical excision procedure (LEEP) is a type of cone biopsy that uses a loop of thin wire to remove abnormal tissue from the cervix. The loop is heated using electricity to remove the tissue. A local anesthetic is used for this procedure, and it can be done in your doctor’s office. A LEEP is also called loop excision or large loop excision of the transformation zone.

Find out more about a LEEP.

A cold knife cone biopsy is a type of cone biopsy that uses a surgical scalpel or a laser to remove the tissue instead of a heated wire. You will either be under general anesthesia (you are asleep) or spinal or epidural anesthesia (you are numb below the waist) during the procedure. It is done in a hospital.

A sentinel lymph node biopsy (SLNB) removes the sentinel lymph node to see if it contains cancer. The sentinel lymph node is the first in a chain or cluster of lymph nodes that receives lymph fluid from the area around a tumour. If cancer cells spread, they will most likely spread to these lymph nodes first. There may be more than one sentinel node, depending on the drainage route of the lymph vessels around the tumour.

Find out more about a sentinel lymph node biopsy (SLNB).

A complete blood count (CBC) is a blood test that examines the numbers and features of blood cells. The 3 types of cells it examines are red blood cells, white blood cells and platelets. A CBC may be done to check for anemia from long-term, or chronic, vaginal bleeding. A CBC also gives doctors a baseline to compare future blood tests to during and after treatment.

Find out more about a complete blood count (CBC).

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are working and can help find problems. Blood chemistry tests used to diagnose cervical cancer include the following:

• Electrolytes, lactate dehydrogenase, uric acid, blood urea nitrogen and creatinine are all tests that check how well the kidneys are working.

• Alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP) tests check how well the liver is working.

An unusual (higher or lower than normal) amount of these levels can be a sign of cancer spread. These tests can also help determine if these organs are healthy enough to cope with and recover from the effects of cancer treatments.

Find out more about blood chemistry tests.

An endoscopy allows a doctor to look inside parts of the body using a flexible tube with a light and lens on the end (called an endoscope).

A cystoscopy uses an endoscope (called a cystoscope) to examine the bladder and urethra. It is done to find out if the cancer has spread to these organs. Doctors can do a biopsy at the same time as a cystoscopy if they find a suspicious area during the exam.

A sigmoidoscopy uses an endoscope (called a sigmoidoscope) to examine the sigmoid colon (the last part of the colon) and the rectum. It is done to find out if the cancer has spread to the rectum. Doctors can do a biopsy at the same time as a sigmoidoscopy if they find a suspicious area during the exam.

Find out more a cystoscopy and a sigmoidoscopy.

An x-ray uses small doses of radiation to make an image of parts of the body on film. A chest x-ray is used to see if cancer has spread to the lungs.

Find out more about x-rays.

A computed tomography (CT) scan uses special x-ray equipment to make 3D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.

A CT scan is used to:

• look at the pelvis, abdomen and lymph nodes around the cervix
• see if cancer has spread to other organs or tissues
• guide the needle when doing a biopsy of an area where the doctor suspects cancer has spread

Find out more about CT scans.

Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3D pictures.

An MRI is used to:

• assess the pelvis, abdomen and lymph nodes around the cervix
• see if cancer has spread to other organs or tissues
• guide the needle when doing a biopsy of an area where the doctor suspects cancer has spread

Find out more about MRIs.

A positron emission tomography (PET) scan uses radioactive materials called radiopharmaceuticals to look for changes in the metabolic activity of body tissues. A computer analyzes the radioactive patterns and makes 3D colour images of the area being scanned. It may be combined with a CT scan, called a PET-CT scan.

A PET scan may be used to find cervical cancer that has come back or has spread to other organs or tissues.

Find out more about PET scans.

Find out more about a diagnosis. To make the decisions that are right for you, ask your healthcare team questions about diagnosis.