The diagnosis of cervical cancer usually begins in your doctor’s office during a routine pelvic exam and Pap test. (To learn about the pelvic exam and Pap test, see cervical cancer screening .) If your Pap test shows abnormal changes or unhealthy cell growth in the cervix, your doctor will need to perform further testing to determine if you have cancer, an infection, or some other condition.
First, the doctor will take your complete personal and family medical history, including information about possible risk factors related to cervical cancer. You will also have a physical exam.
Testing
The initial diagnosis of cervical cancer can be made from the screening Pap test done in the physician’s office. However, additional diagnostic tests are necessary to determine the precise type, location and extent of tumor to plan effective treatment.
Diagnostic tests will determine the nature of the abnormal cell growth of the cervix. Diagnostic tests include:
Colposcopy —In this procedure, the doctor uses a colposcope, an instrument that shines a light on the cervix and magnifies the view, to examine your genitals, vagina, and cervix closely.
The doctor places the speculum into your vagina and opens it slightly to see the cervix. A vinegar solution is swabbed onto the cervix and vagina. This solution makes abnormal tissue turn white so the doctor can identify the areas that need to be evaluated. If abnormal cells are found during a colposcopy, the doctor may do a biopsy.
Biopsy —During a biopsy, the doctor removes a small amount of cervical tissue for examination. There are several procedures used to obtain biopsies, including:
Cone biopsy (also known as cold cone biopsy or cold knife cone biopsy) —a procedure that uses a laser or a surgical scalpel to remove tissue
Loop electrosurgical excision procedure (LEEP) —a procedure that uses an electric wire loop to slice off a thin, round piece of tissue
Endocervical curettage —a procedure that uses a small, spoon-shaped instrument called a curette to scrape tissue from inside the cervical opening
If the area of abnormal cell growth is small, these biopsy procedures may be able to remove all of the affected area. The tissue removed during biopsy is sent to a laboratory to be analyzed.
Staging
If cancer is found, your prognosis and treatment depend on the location, size, and stage of the cancer and your general health.
Staging is a careful attempt to determine whether the cancer has spread and, if it has, what body parts are affected. Additional tests to determine staging may include:
- Urine and blood tests
- Additional physical exam, including another pelvic exam in the operating room under anesthesia
- X-rays of various parts of the body, including lungs, bladder, kidney, lymph nodes
- Barium enema —to check intestines and rectum, helps to show the lower gastrointestinal tract on an x-ray
- CT or CAT scan—a series of x-rays put together by a computer to make detailed pictures of areas inside the body
- Ultrasonography—a procedure in which sound waves are bounced off tissues and the echoes produce a picture
- MRI —a procedure in which a magnet linked to a computer is used to create detailed pictures of areas inside the body
The following staging system is used to classify cancer of the cervix:
- Stage 0—The abnormal cells are found only in the first layer of cells lining the uterus.
- Stage I—Cancer involves the cervix but is still confined to the uterus. This stage has six levels depending upon the size of the cancer: IA, IA1, IA2, IB, IB1, and IB2.
- Stage II—Cancer has spread to nearby areas but is still inside the pelvic area. This stage has two levels depending upon whether the cancer has spread to the upper two-thirds of the vagina (IIA) or into the pelvis (IIB).
- Stage III—Cancer has spread throughout the pelvic area. This stage has two levels depending on whether there is the cancer has spread to the lower-third of the vagina (IIIA) or more broadly into the oelvis (IIIB).
- Stage IV—Cancer has spread to other parts of the body. This stage has two levels depending on which organs the cancer has spread to: bladder, rectum or both (IVA); or, more distant organs (IVB).