How Is Cervical Cancer Diagnosed?

If you have some of the symptoms of cervical cancer or your Pap test shows some abnormal cells, your doctor will begin your diagnosis with a medical history and physical exam. 

• Medical history and physical examination - The doctor checks you for risk factors and symptoms of cervical cancer. He or she also does a complete physical exam to help evaluate your overall health, paying special attention to your lymph nodes (tiny organs shaped like beans that can be found throughout the body), for evidence of metastasis (cancer spread).

If your doctor finds cervical abnormalities during a pelvic examination or a Pap test, he or she will probably perform a cervical biopsy.

• Biopsy - The doctor removes tissue samples from the cervix. A pathologist examines the tissue under a microscope to determine if cancer or other abnormal cells are present. The diagnosis of cancer can only be confirmed by a biopsy.
  
  Several types of cervical biopsies can be used to remove tissue for cervical cancer diagnosis. Some procedures only require local anesthetic (drugs that cause a temporary loss of feeling in one part of the body), while others require general anesthetic (drugs that cause a loss of feeling or awareness and put the person to sleep). Some of these procedures completely remove areas of abnormal tissue and can also be used to treat precancerous lesions.
  • Colposcopy - The doctor uses an instrument called a colposcope to examine the cervix for abnormalities. The colposcope combines a bright light with a magnifying lens to make tissue easier to see. 
  • Cone biopsy (also called conization) - The doctor removes a cone-shaped piece of tissue using a surgical scalpel (cold knife cone biopsy) or laser. Conization can also be done by passing an electrical current through a wire loop (loop electrosurgical excision procedure, or LEEP). Conization lets the pathologist see if abnormal cells are in the tissue beneath the surface of the cervix. This procedure can also be used to remove precancerous cells.
  • Endocervical curettage (ECC) - The doctor uses a narrow spoon-shaped instrument, called a curette, or a thin, soft brush to scrape a sample from the lining of the cervical canal.
  • Punch biopsy - The doctor uses a sharp, hollow device to pinch off small samples of cervical tissue.

If the biopsy shows that you have cervical cancer, your doctor will refer you 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 doctor re-examines the pelvic area while you are under anesthetic to see if the cancer has spread to organs near the cervix, including the uterus, vagina, bladder, and rectum.
• Cystoscopy - The doctor examines the inside of the bladder and urethra (canal that carries urine from the bladder) with a cystoscope (a thin, flexible tube with a camera). A cystoscopy can show whether the cancer has spread to the bladder.
• Proctoscopy (also called a sigmoidoscopy) - The doctor examines the colon and rectum using a sigmoidoscope (a thin, flexible tube with a camera) to see if the cancer has spread to the rectum.

Your doctor might also order some of these imaging tests to show whether the cancer has spread beyond the cervix.

• Chest x-ray - An x-ray of your chest can show if your cancer has spread to your lungs.
• Computed tomography (CT) - Instead of taking one picture, such as a conventional x-ray, a CT scanner takes many pictures as it rotates around you. A computer is used to combine these pictures into an image of a slice of your body (like a loaf of sliced bread). A CT scan of the chest is more sensitive than an x-ray. A CT scan of the abdomen evaluates the extent of the cancer and the organs inside the abdomen.
• Intravenous urography (also called intravenous pyelogram, or IVP) - A series of x-rays are taken of the urinary tract after a contrast dye is injected into the bloodstream through a vein. The dye makes the bladder and other organs easier to see on the x-rays. This test can be used to rule out other diseases or find abnormalities of the urinary tract, such as changes caused by the spread of cervical cancer to the pelvic lymph nodes, which can block the flow of urine to the bladder. You will probably not need an IVP if you have already had a CT scan or MRI.
• Magnetic resonance imaging (MRI) - This procedure uses powerful magnets and radio waves to take detailed cross-sectional images. MRI produces images of cross-sectional slices of your body like a CT scanner; it can also produce images of slices that are parallel to the length of your body. MRI images are particularly useful in examining pelvic tumors. They are also helpful in detecting cancer that has spread to the brain or spinal cord.
• Positron emission tomography (PET) - Cancer cells use glucose (sugar) more quickly than most other body organs. During a PET scan, the doctor will inject a small amount of glucose that has a radioactive atom into your arm. A special camera in the PET machine can detect the radioactivity. This test is useful to see if the cancer has spread to lymph nodes or to help your doctor when he or she thinks the cancer has spread but doesn’t know where.

This content has been reviewed and approved by Myo Thant, MD.