Cervical Cancer Diagnosis

How is Cervical Cancer Diagnosed?

medical chart with diagnosis cervical cancer written on the front
How is cervical cancer diagnosed?. Istockphoto.com/Stock Photo©designer491

If you've heard of someone who has cervical cancer, if you have any pelvic symptoms, or if you have had an abnormal Pap smear, you may be wondering how cervical cancer is diagnosed. Let's look at what symptoms may suggest a cancer is present, screening methods, and specific tests such as colposcopy and biopsy procedures which are used in the diagnosis of this disease.

Signs and Symptoms of Cervical Cancer vs Screening

Cervical cancer is often found before any symptoms are present; in other words, a person is usually asymptomatic.

When screening guidelines for cervical cancer are followed, this is often the case, though there are times when the first sign that something is wrong may be symptoms.

Cervical Cancer Symptoms

Unlike other types of cancer, cervical cancer symptoms do not usually appear until the cancer has progressed to a fairly advanced stage. Because most women do not experience symptoms that prompt them to seek medical treatment, a regular Pap smear is essential for early detection. When symptoms are present they may include:

  • Abnormal uterine bleeding - This can be bleeding that is heavier or lighter than normal, occurs between periods or after intercourse, or occurs after menopause
  • Urinary frequency
  • Pelvic pain, especially during intercourse
  • Vaginal discharge

The Pap Smear

The Pap smear plays a vital role in diagnosing cervical cancer. It is how most women discover they suffer from cervical dysplasia or cervical cancer.

A Pap smear is a simple test that can reveal cervical abnormalities long before they progress into cancer.

All women should have a regular Pap smear, unless their physician has advised them they no longer need one. This may also include post-menopausal women and those who have had hysterectomies. Make sure you avoid common Pap smear mistakes, so that your tests are as accurate as possible.

HPV Testing

HPV testing is another important test which may be done at the same time as a Pap smear or following an abnormal result. It's important to note that if you are over the age of 30, you may ask to have an HPV test done.

Take time to learn about the human papillomavirus (HPV). While there are over 100 strains of the virus, not all of these cause cancer. Around 70 percent of cervical cancers are caused by HPV 16 and HPV 18, with another 20 percent of cervical cancers being related to infection with HPV 31, 33, 34, 45, 52, and 58.

Abnormal Pap Smears

There are a wide range of abnormalities that may be detected on a Pap smear, not all of which mean you are at risk of developing cervical cancer. If you have an abnormal Pap smear it is extremely important that you follow up on recommendations from your doctor, whether that be a coloposcopy, some form of cervical biopsy, or only a repeat Pap smear in a year. Take a moment to learn about the different types of abnormal Pap smear results and the medical terminology used to describe these.

Colposcopy Exam

If your Pap smear reveals cervical abnormalities, a colposcopy may then be scheduled. A colposcopy is an in-office exam that allows the doctor to view the cervix more closely with a colposcope.

A colposcope is a lighted instrument that magnifies the cervix (like having a Pap smear under a microscope.) It rests externally, outside of the vagina, during the exam. The images seen from the colposcope may be projected on a computer or television screen. You are not obligated to watch, but it may help you understand the exam better.

Cervical Biopsy and Endocervical Curettage

During the colposcopy, the doctor may perform a cervical biopsy depending on what is found during the exam. A cervical biopsy  involves removing small amount of cervical tissue to be examined under a microscope. Most often this is a punch biopsy, in which the doctor removes a small sample of tissue with a device similar to a paper punch.

It takes only seconds for the doctor to gain a tissue sample and is only momentarily uncomfortable. Depending on the findings during the colposcopy, a few areas of the cervix may be biopsied.

Along with a cervical biopsy, an endocervical curettage (ECC) may also be done. During an ECC, the doctor uses a small brush to remove tissue from the endocervical canal, the narrow area between the uterus and cervix. An ECC can be moderately painful (like bad menstrual cramps), but the pain disappears when the ECC is done.

Biopsy and ECC results usually take less than two weeks to return. Your doctor may have you schedule another visit to go over the results with you or she may call you by phone to inform you of the results.

Cone Biopsy and LEEP

There are times when a larger biopsy needs to be done to diagnose cervical cancer or remove tissue so that it does not become cancerous. In these cases, a cone biopsy may be performed. During a cone biopsy, a cone shaped piece of tissue is removed under general anesthesia. A cone biopsy is also used to remove precancerous tissue from the cervix.

An alternative to cone biopsy, a loop electro surgical excision procedure (LEEP) is a procedure done under local anesthesia to remove tissue from the cervix. A LEEP uses an electrically charged wire loop to remove a tissue sample. This method is more commonly used to treat high grade cervical dysplasia, rather than diagnose cervical cancer.

The Results of Your Cone Biopsy or LEEP Procedure

Once the biopsy results return, cervical cancer can either be ruled out or diagnosed. If a cervical cancer diagnosis is made, the next step is to determine the stage of the cervical cancer. There are five cervical cancer stages and each represents how far advanced the cancer has spread.

Once the stage of cervical cancer has been determined, a treatment plan can then be developed. Treatment may include further surgery, chemotherapy, radiation therapy, or newer treatments available in clinical trials.

Sources:

Kudela, E., Holubekova, V., Farkasova, A., and J. Danko. Determination of the Malignant Potential of Cervical Intraepithelial Neoplasia. Tumour Biology. 2016. 37(2):1521-5.

TSikouras, P., Zervoudis, S., Manav, B. et al. Cervical Cancer: Screening, Diagnosis and Staging. J BUON. 2016. 21(2):320-5.

Zorzi, M., Del Mistro, A., Farruggio, A. et al. Use of a High-Risk Human Papillomavirus DNA Test as the Primary Test in a Cervical Cancer Screening Programme: A Population-Based Cohort Study. BJOG. 2013. 120(10):1260-7.

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