Diagnosis is the process of finding the underlying cause of a health problem. If cancer is suspected, the healthcare team will confirm if it is present or not, and what type of cancer it is. The process of diagnosis may seem long and frustrating, but it is important for the doctor to rule out other possible reasons for a health problem before making a cancer diagnosis.
Diagnostic tests for cervical cancer are usually done when:
- the symptoms of cervical cancer are present, such as abnormal vaginal bleeding
- the doctor suspects cervical cancer after talking with a woman about her health and completing a physical examination
- a routine test (such as a Pap test) suggests abnormal changes in the cells of the cervix
Many of the same tests used to initially diagnose cancer are also used to determine the stage (how far the cancer has progressed). Your doctor may also order other tests to check your general health and to help plan your treatment. Tests may include the following.
Medical history and physical examination
The medical history is a record of present symptoms, risk factors and all the medical events and problems a person has had in the past. The medical history of a woman's family may also help the doctor to diagnose cervical cancer.
In taking a medical history, the doctor will ask questions about:
- a personal history of
- sexual activity and reproduction
- HPV infection
- prior abnormal Pap tests and treatment for these abnormalities
- smoking
- taking drugs that suppress the immune system (immunosuppressant drugs)
- human immunodeficiency virus (HIV) infection
- exposure to diethylstilbestrol (DES) before birth
- oral contraceptive use
- a family history of cervical cancer
- signs and symptoms that may suggest cervical cancer
A physical examination allows the doctor to look for any signs of cervical cancer. During a physical examination, the doctor may:
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Pap test
A Pap test is a procedure that scrapes a small sample of cells from the surface of the ectocervix so the cells can be examined for abnormal changes. It can detect changes early, before cancer develops. A Pap test is usually used to screen for cervical cancer.
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Complete blood count
A complete blood count (CBC) measures the number and quality of white blood cells, red blood cells and platelets. A CBC is done to:
- check for anemia from long-term vaginal bleeding
- provide a baseline for comparison of future blood cell counts taken during and after treatment
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Blood chemistry tests
Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are functioning and can also be used to detect abnormalities. Blood chemistry tests are also used to stage cervical cancer since increased levels may indicate that the cancer has spread to the kidneys or liver.
- Urea (blood urea nitrogen, or BUN) and creatinine measure kidney function.
- Alanine aminotransferase (ALT), aspartate transaminase (AST) and alkaline phosphatase measure liver function.
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Colposcopy
Colposcopy is a type of endoscopy. It is done to examine the outer surface of the cervix (ectocervix) and the lower portion of the inner cervix (endocervix) more closely if symptoms suggest precancerous conditions of the cervix or cervical cancer. Colposcopy may also be done when a change or abnormality is found during a Pap test or clinical examination.
A colposcopy is done much the same way as a Pap test.
- A speculum is inserted into the vagina to hold it open so the cervix can be clearly seen and examined.
- The doctor uses a special instrument called a colposcope. It has a light and magnifying lens (much like binoculars) on the end, which allows the inside surface of the cervix and the vagina to be seen more clearly under high magnification. The colposcope itself isn't inserted – it is positioned outside the opening of the vagina.
- The area may be swabbed with solutions that help the doctor see the tissues better.
- Biopsies may be taken from any suspicious areas using forceps or a scoop called a curette.
A colposcopy can usually be done if a woman is pregnant. It should not be done during menstruation. Avoid sexual intercourse, vaginal douches, vaginal medications and contraceptive (spermicidal) creams, foams and gels (except as directed by the doctor) for 48 hours before the test since these can interfere with the procedure and potentially affect the results.
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Biopsy
If a Pap test shows abnormal cells, the doctor will often need to take a biopsy from the cervix. During a biopsy, tissues or cells are removed from the body so they can be tested in a laboratory. The pathology report from the laboratory will confirm whether or not cancer cells are present in the sample.
There are several biopsies that can be used for the cervix.
Colposcopic biopsy
This biopsy is done during colposcopy.
- A local anesthetic may be used to numb the cervix.
- Biopsy forceps are used to remove small amounts of tissue from suspicious-looking areas, mainly in the lower part of the cervix (ectocervix).
- The procedure may cause mild cramping or discomfort (similar to menstrual cramps), and there may be some light vaginal bleeding afterward.
Endocervical curettage
This biopsy is done during colposcopy.
- A local anesthetic may be used to numb the cervix.
- A narrow, spoon-shaped tool called a curette is used to gently scrape cells and tissue from the endocervical canal.
- The procedure may cause mild cramping or discomfort (similar to menstrual cramps), and there may be some light vaginal bleeding afterward.
Cone biopsy (cervical conization)
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. A cone biopsy may be done in one of 3 ways:
- The loop electrosurgical excision procedure (LEEP) uses a thin wire loop heated by an electrical current to remove cervical tissue.
- Cold-knife excision uses a surgical scalpel to remove cervical tissue.
- Laser excision uses a laser to remove cervical tissue.
CT-guided biopsy
A biopsy may be taken from abnormal or suspicious lymph nodes in the groin or above the collarbone. A CT scan is used to guide the insertion of the biopsy needle (CT-guided biopsy) into the lymph nodes.
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Urinalysis
A urinalysis is a routine urine test that describes the colour, appearance and contents of a urine sample. It is done to find abnormalities such as blood in the urine. Blood in the urine means that there is bleeding somewhere in the urinary tract (kidneys, ureters, bladder or urethra), which may indicate that cancer has spread to the urinary system.
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Endoscopy
Endoscopy procedures such as cystoscopy and sigmoidoscopy are done in women who have symptoms suggesting that cancer may have spread to the bladder or rectum. These tests are also done to help stage more advanced cervical cancers.
- A cystoscopy is done to find out if the cancer has spread to the bladder and urethra. A biopsy can be performed at the same time as cystoscopy if the doctor finds a suspicious area during examination.
- A sigmoidoscopy is done to find out if the cancer has spread to the rectum. A biopsy can be performed at the same time if the doctor finds a suspicious area during examination.
A thorough pelvic examination may be done at the same time as the cystoscopy or sigmoidoscopy, while the woman is under general anesthesia. The doctor will check for spread of the cancer to the vagina or surrounding structures.
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Chest x-ray
An x-ray uses small doses of radiation to make an image of the body’s structures on film. A chest x-ray may be done to detect the spread of cancer to the lungs.
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Barium enema
A barium enema may be done to find out if cancer has spread to the rectum.
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Computed tomography (CT) scan
A CT scan uses special x-ray equipment to make 3-dimensional and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures. It is used to:
- find out the extent of the cervical tumour
- see if there is cancer in the nearby organs and tissues in the pelvis
- see if there is cancer in the liver and lungs
- see if there is cancer in the surrounding lymph nodes
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Magnetic resonance imaging (MRI)
MRI uses powerful magnetic forces and radio-frequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3-dimensional pictures. It is used to:
- find out the extent of the cervical tumour
- see if there is cancer in the nearby organs and tissues in the pelvis
- see if there is cancer in the brain and spinal cord
- see if there is cancer in the surrounding lymph nodes
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Intravenous pyelogram
An intravenous pyelogram (IVP) is a special x-ray of the urinary system. It may be used to see if cancer is blocking (obstructing) the ureters. IVP may not be needed if a CT scan using contrast medium or an MRI has been done.
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Positron emission tomography (PET) scan
A PET scan uses radioactive materials (radiopharmaceuticals) to detect changes in the metabolic activity of body tissues. A computer analyzes the radioactive patterns and makes 3-dimensional colour images of the area being scanned. A PET scan is usually done in conjunction with a CT scan (PET/CT). It is used to see if the cancer has spread beyond the cervix. PET scans are rarely done in people with early stage cervical cancer.
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See a list of questions to ask your doctor about diagnostic tests.