Tests and diagnosis of Cervical Cancer

Cervical cancer that is detected early is more likely to be treated successfully. To detect cervical cancer and precancerous changes, Screening tests include :

• Pap test. During a Pap test, your doctor scrapes and brushes cells from your cervix, which are then examined in a lab for abnormalities.A Pap test can detect abnormal cells in the cervix, including cancer cells and cells that show changes that increase the risk of cervical cancer.
• HPV DNA test. The HPV DNA test involves testing cells collected from the cervix for infection with any of the types of HPV that are most likely to lead to cervical cancer. This test may be an option for women age 30 and older, or for younger women with an abnormal Pap test.

If the Pap test showed some abnormal cells, and the HPV test is also positive, the doctor may suggest one or more of the following diagnostic tests:

Colposcopy. The doctor may do a colposcopy to check the cervix for abnormal areas. A special instrument called a colposcope (an instrument that magnifies the cells of the cervix and vagina, similar to a microscope) is used. The colposcope gives the doctor a lighted, magnified view of the tissues of the vagina and the cervix. The colposcope is not inserted into the woman’s body and the examination is not painful, can be done in the doctor′s office, and has no side effects. It can be done on pregnant women.

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed during the biopsy is analyzed by a pathologist. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. If the lesion is small, the doctor may remove all of it during the biopsy. There are several types of biopsies:

• One common method uses an instrument to pinch off small pieces of cervical tissue.
• Sometimes, the doctor wants to check an area inside the opening of the cervix that cannot be seen during a colposcopy. To do this, the doctor uses a procedure called endocervical curettage (ECC). Using a small, spoon-shaped instrument called a curette, the doctor scrapes a small amount of tissue from inside the cervical opening.
• A loop electrosurgical excision procedure (LEEP) uses an electrical current passed through a thin wire hook. The hook removes tissue for examination in the laboratory. A LEEP may also be used to remove a precancer or an early-stage cancer.
• Conization (a cone biopsy) removes a cone-shaped piece of tissue from the cervix. Conization may be done as treatment to remove a precancer or an early-stage cancer.

The first three procedures are usually done in the doctor′s clinic using a local anesthetic to numb the area.

There may be some bleeding and other discharge and, for some women, discomfort similar to menstrual cramps. Conization is done under a general or local anesthetic and may be done in the doctor′s clinic or the hospital.

If the biopsy indicates that cervical cancer is present, the doctor will refer the woman to a gynecologic oncologist, who specializes in treating this type of cancer. The specialist may suggest additional tests to see if the cancer has spread beyond the cervix.

Pelvic examination. The specialist may re-examine the pelvic area while the patient is under anesthetic 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 to create a picture of the structures inside of the body using a small amount of radiation. An intravenous urography is a type of x-ray that is used to view the kidneys and bladder.

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill to swallow.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow.

Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

Cystoscopy. This procedure allows the doctor to view the inside of the bladder and urethra (canal that carries urine from the bladder) with a thin, lighted, flexible tube called a cystoscope. The person may be sedated as the tube is inserted in the urethra. A cystoscopy is used to determine whether cancer has spread to the bladder.

Proctoscopy (also called a sigmoidoscopy). This procedure allows the doctor to see the colon and rectum with a thin, lighted, flexible tube called a sigmoidoscope. The person may be sedated as the tube is inserted in the rectum. A proctoscopy is used to see if the cancer has spread to the rectum.

Laparoscopy. This procedure allows the doctor to see the abdominal area with a thin, lighted, flexible tube called a laparoscope. The person may be sedated as the tube is inserted through an incision in the body.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging.