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Diagnosis of cervical 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 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 process of diagnosis may seem long and frustrating. It’s normal to worry, but try to remember that other health conditions can cause similar symptoms as cervical cancer. It’s important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of cervical cancer.
The following tests are commonly used to rule out or diagnose cervical cancer. Many of the same tests used to diagnose cancer are used to find out the stage, which is how far the cancer has progressed. 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, risk factors and all the medical events and problems you have had in the past. In taking a health history, your doctor will ask questions about a personal history of:
- symptoms that suggest cervical cancer
- sexual activity
- abnormal Pap tests and treatments
A physical exam allows your doctor to look for any signs of cervical cancer. During a physical exam, your doctor may:
- do a pelvic exam
- do a digital rectal exam (DRE) to feel for a lump or thickened area
- feel the lymph nodes in the groin and above the collarbone to see if they are swollen
A Pap test is a procedure that removes a small sample of cells from the surface of 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 1 to 3 years, depending on your province’s or territory’s screening guidelines and your health history. If you have symptoms of cervical cancer and haven’t had a recent Pap test, your doctor may do one during the physical exam.
Find out more about Pap test.
A human papillomavirus (HPV) test is a lab test that looks for the DNA of high-risk types of HPV linked to cervical cancer. In some cases, the HPV test can be done on the same sample of cells collected during a Pap test.
Find out more about HPV test.
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 much the same way as 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. Avoid sexual intercourse, vaginal douches, vaginal medicines and contraceptive (spermicidal) creams, foams and gels (except as directed by your doctor) for 48 hours before the test. These should be avoided because they can interfere with the procedure and may affect the test results.
A pregnant woman can have a colposcopy if her doctor recommends it.
If a Pap test returns abnormal results, 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 looked at under the microscope to see if cancer cells are present in the sample.
This biopsy is done during a colposcopy. A local anesthetic (freezing) may be used to numb the cervix. The doctor uses biopsy forceps to remove small amounts of tissue from suspicious-looking areas in the cervix or vagina.
The procedure may cause mild cramping or pain. You may have some light vaginal bleeding after a colposcopic biopsy.
This biopsy is done during a colposcopy. A local anesthetic may be used to numb the cervix. The doctor uses a curette to gently scrape cells and tissue from the endocervical canal. A curette is a narrow, spoon-shaped tool.
The procedure may cause mild cramping or discomfort (similar to menstrual cramps). You may have some light vaginal bleeding after an endocervical curettage.
Endometrial biopsy is a procedure that uses a special tool, called a pipelle, to remove cells from the lining of the inside of the uterus (called the endometrium) so they can be examined under a microscope to check for cancer. It 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.
There are 3 ways to do a cone biopsy:
- 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 (an intense, narrow beam of light) to remove cervical tissue.
Depending on the way the cone biopsy is done, it may be done during a colposcopy or as a separate procedure in an operating room. A cone biopsy may be all the treatment you need for a precancerous condition of the cervix.
Find out more about cone 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 biopsy needle to the lymph nodes to collect samples from them.
Para-aortic lymph node biopsy
Women who have been diagnosed with stage IV cervical cancer may need surgery to biopsy the lymph nodes at the back of the abdomen (called the para-aortic lymph nodes). If these lymph nodes have cancer cells in them, the doctor will likely do more tests to see if the cancer has spread to other parts of the body before beginning treatment.
Sentinel lymph node biopsy
Sentinel lymph node biopsy (SLNB) is a procedure used to remove the sentinel lymph node to see if it contains cancer. The sentinel lymph node is the first lymph node in a chain or cluster of lymph nodes that receives lymph fluid from the area around a tumour. Cancer cells will most likely spread to these lymph nodes. There may be more than one sentinel node, depending on the drainage route of the lymph vessels around the tumour.
SLNB may be offered to women with stage I cervical cancer. A doctor may do SLNB to try to avoid doing a pelvic lymph node dissection (PLND), which removes more lymph nodes from the pelvis. If the sentinel lymph node contains cancer, the surgeon will then do PLND, in most cases. Your healthcare team will discuss your options with you to decide the best treatment based on your personal needs.
Learn more about sentinel lymph node biopsy (SLNB).
A CBC measures the number and quality of white blood cells, red 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 complete blood count (CBC).
Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are functioning and can help find abnormalities.
Blood chemistry tests are done to check kidney and liver function as part of the diagnosis process for cervical cancer. They 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 body cavities using a flexible tube with a light and lens on the end. If a woman has a large cervical tumour, an endoscopy is done to see if the cancer may have spread to the bladder or rectum. It may also be done to help stage more advanced cervical cancers.
Cystoscopy is a procedure that 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.
Sigmoidoscopy is a procedure that 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.
The doctor may do a pelvic exam and digital rectal exam (DRE) at the same time as a cystoscopy or sigmoidoscopy. These exams allow the doctor to check if the cancer has spread to the vagina and surrounding structures.
An x-ray uses small doses of radiation to make an image of the body’s structures on film. A chest x-ray is used to see if cancer has spread to the lungs.
Find out more about x-ray.
A barium enema is an x-ray procedure that uses a contrast medium, or special dye, called barium sulphate. It is used to check if cancer has spread to the colon or rectum.
Find out more about barium enema.
A computed tomography (CT) scan uses special x-ray equipment to make 3-D 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 may be used to:
- check the size of the tumour
- find out if cancer has spread to nearby organs and tissues in the pelvis
- find out if cancer has spread to the liver and lungs
- find out if cancer has spread to lymph nodes
- guide a needle for a biopsy
A CT scan may also be used to help doctors determine prognosis, measure response to treatment and check if cancer has come back, or recurred.
A dye (contrast medium) may be injected into a vein (given intravenously) before the CT scan. The dye can help the doctor see structures of the body better than without contrast. Tell your doctor or the radiology staff if you have had an allergic reaction to a contrast medium in the past.
Find out more about CT scan.
Magnetic resonance imaging (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-D pictures.
An MRI is used to find out if cancer has spread to:
- nearby organs and tissues in the pelvis
- the brain or spinal cord
- lymph nodes
An MRI may also be used to help doctors determine prognosis, measure response to treatment and check if cancer has come back, or recurred.
Find out more about MRI.
An intravenous pyelogram (IVP) is a special x-ray of the urinary system. It may be used to see if cancer is blocking, or obstructing, the ureters (tubes that connect the kidneys to the bladder). An IVP may not be needed if a CT scan using a contrast medium or an MRI has been done.
Find out more about intravenous pyelogram (IVP).
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 3-D colour images of the area being scanned.
A PET scan is rarely used for women with early stage cervical cancer. It may be combined with a CT scan (PET/CT scan) to check the size of the tumour and see if the cancer has spread beyond the cervix. A PET scan may also be used to help doctors determine prognosis, measure response to treatment and check if cancer has come back, or recurred.
Find out more about PET scan.
Questions to ask your healthcare team
The outer female sex organs, including the clitoris, vaginal lips (folds of skin that surround the opening of the vagina) and the opening to the vagina.
Vulvar means referring to or having to do with the vulva, as in vulvar cancer.
The muscular tube found in the pelvis of women between the bladder and rectum. The vagina extends from the cervix (the lower part of the womb) to the vulva (the outer part of the genitals).
Menstrual fluid passes out of the body through the vagina. During childbirth, the baby passes through the vagina.
Also called the birth canal.