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How is cervical cancer diagnosed?

The tests and procedures used in the cervical cancer diagnosis include:

Bimanual pelvic examination
Pap test
Endocervical Curettage
HPV test
Colposcopy
Biopsy
Pelvic examination under anesthesia
X-ray
Computed tomography (CT or CAT) scan
Magnetic resonance imaging (MRI)
Positron emission tomography (PET) or PET-CT scan
Cystoscopy
Sigmoidoscopy

Bimanual Pelvic Examination:

The doctor will check a woman’s body in this examination for any unusual changes in her cervix, vagina, uterus, ovaries and other nearby organs. The doctor will look out for any changes in the vulva of the woman outside the body and then, using a device called a speculum the doctor will look inside the body of the woman to hold the vaginal walls intact. During this test, some of the surrounding organs are not visible, so the doctor will insert 2 fingers into the patient’s vagina, while the other hand will gently press the lower abdomen to feel the uterus and ovaries. This exam usually takes a couple of minutes and is conducted at the doctor’s clinic in an examination room. A Pap test is usually done at the same time.

Pap test:

The doctor gently scrapes the exterior of the cervix and the vagina taking cell samples for examination during a Pap test. Improvements in the methods of Pap test have made it easier for doctors to detect cancer cells.

Traditional Pap tests can be difficult to observe as cells can be dried out, coated with mucus or blood, or clumped onto the slide.

The liquid-based cytology test, also called ThinPrep or SurePath moves a thin layer of cells onto a slide upon extracting blood or mucus from the sample. The same sample can be used to carry out tests such as the HPV test at the same time
Computer screening also called AutoPap or FocalPoint, tests the sample for abnormal cells using a computer

Endocervical Curettage:

Endocervical curettage (ECC) is a pathological technique used to identify cancer cells found in the cervix. In this procedure, a spoon-shaped surgical instrument called Curette is used to remove tissues from the endocervical canal. The technique lets the doctor assess the cell abnormality clinically and to conduct further investigations if required.

HPV Test

An HPV test is similar to a Pap test in which the sample of cervical cells from the patient are examined. The doctor can check for HPV at the same time as a Pap test or after Pap test results end up in showing abnormal changes in the cervix. When the doctor claims the HPV test is “positive,” then this means that the test detected HPV strains such as HPV16 or HPV18. Many women have HPV but no cervical cancer, so HPV testing alone is not enough for a cervical cancer diagnosis.

Colposcopy

The doctor can do a colposcopy test to check for abnormal areas in the cervix. A special instrument called a colposcope is used which in this procedure. The colposcope magnifies the cervix and vagina cells, just like a microscope. This helps the doctor to observe a luminous, magnified image of the vagina and cervix tissues. The colposcope is not inserted into the woman’s body, nor is the test painful. It can be done at the doctor’s clinic and has no side effects. It can be done even in the pregnant women.

Biopsy

A biopsy is the removal of a small amount of tissue to examine under a microscope. Other tests can indicate the presence of cancer but a definitive diagnosis is allowed only through a biopsy. The sample(s) are then analysed by a pathologist. The doctor may remove all of it during the biopsy if the lesion is small.

There are several types of biopsies performed in the doctor’s clinic using a local anesthetic to numb the area. During this procedure, there may be some bleeding and other discharge. Some women may even experience discomfort similar to menstrual cramps.

One of the most common method is pinching small pieces of cervical tissue using an instrument
The doctor needs to test the region within the cervix opening which is not noticeable during colposcopy. For this the doctor uses an endocervical curettage technique. A flat, spoon-shaped tool called a curette is used by the doctor to scrape a small amount of tissue from inside the cervical opening
The loop electrosurgical excision technique (LEEP) uses an electrical current that passes through a thin pin where the hook removes tissue for examination. A LEEP may also be used to remove precancer or early cancer
Conization or a cone biopsy of cervix extracts a fragment of tissue that is cone shaped from the cervix. It can be performed as a treatment to remove a precancer or early-stage cancer. It is done under a general or local anesthetic in the doctor’s or clinic or hospital

When the biopsy reveals the presence of cervical cancer, the doctor should refer the woman to a gynecological oncologist, a specialist who is specialized in treating this form of cancer. The specialist may propose further testing to see if the cancer has spread beyond the cervix.

Pelvic Examination Under Anesthesia

In cases where treatment planning is needed, the surgeon can re-examine the pelvic region while the patient is under anesthesia to see if the cancer has spread to any organs near the cervix, including the uterus, vagina, bladder, or rectum.

X-ray

An x-ray is a way of using a small amount of radiation to produce an image of the structures within the body. It can help the doctor to identify if the cancer has spread to lungs and other parts of the body.

Computed tomography (CT or CAT) scan

A CT scan for cervical cancer takes pictures of the interior body using x-rays from different angles. A computer uses these images and combine into a detailed 3-dimensional image that reveals any abnormalities or tumors. A CT scan can be used to measure the size of the tumor. A special dye called a contrast medium is given before the scan to provide more detail on the image. Such dye can be injected into the vein of a patient, or given to swallow as a pill or liquid.

Magnetic Resonance Imaging (MRI)

The MRI uses magnetic fields to create accurate images of the body. It can also be used to measure the size of the tumor. Before the scan is done, a special dye called a contrast medium is injected into the vein of a patient, or given to swallow as a pill or liquid to produce a clear image.

Positron Emission Tomography (PET) or PET-CT scan

In general, a PET scan is combined with a CT scan called as PET-CT scan. A PET scan is a means of generating pictures of tissues and organs within the body. A small quantity of a radioactive sugar is injected into the patient’s body. Cells which use the most energy consume this sugar content. Since cancer appears to aggressively use radiation, it consumes more of the radioactive material. Then a scanner detects the material to create images of the interior cervix.

Cystoscopy

A cystoscopy is a procedure that allows the doctor to have interior view of bladder and urethra using a small, lighted tube called a cystoscope. The individual can be sedated when inserting the tube into the urethra. A cystoscopy is used to determine if cancer has spread to the bladder.

Sigmoidoscopy

A sigmoidoscopy, also known as a proctoscopy, is a procedure that allows the doctor to see into the colon and rectum through a small, lighted, transparent tube called a sigmoidoscope. The person can be sedated when inserting the tube into the rectum. A sigmoidoscopy is used to determine if the cancer has spread to the rectum.

Tests to Stage Cervical Cancer

If your doctor determines that you have cervical cancer, then you will have additional testing to assess the extent (stage) of your cancer. The stage of the cancer is a key factor during your treatment.

Staging tests include:

Imaging tests: X-ray, CT, MRI and positron emission tomography (PET) tests help your doctor determine if your cancer has spread outside your cervix
Visual inspection of your bladder and rectum: Special scopes can be used by your doctor to see the interior bladder and rectum for cancer spread

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