Cervical Cancer Screening and Diagnosis

Accurate diagnosis to give you a head start in the fight against cervical cancer.

More than 13,000 U.S. women are diagnosed with invasive cervical cancer each year. All cervical cancer starts with precancerous cells in the lining of the cervix. If precancerous cells become cancer cells, they grow uncontrollably and may form a tumor. Sometimes, the cancer moves to other parts of the body. 

With early diagnosis and treatment of precancerous cells, most cervical cancers can be prevented. 

There are three main types of cervical cancer: 

• Squamous cell carcinoma (cancer) develops in the lining of the cervix. It is found in 80 to 90 percent of cervical cancer cases.
• Adenocarcinoma is a cancerous tumor that develops in the cells that produce mucus in the cervix. Approximately 10 to 20 percent of cervical cancers are adenocarcinomas. 
• Adenosquamous or mixed carcinoma (cancer) involves both adenocarcinoma and squamous cell carcinoma.

Other types of cancer may be found in the cervix, including neuroendocrine, melanoma, sarcoma, and lymphoma; however, these are rare.

Signs and symptoms of cervical cancer

In the early stages of cervical cancer, women usually do not have any symptoms. As cervical cancer advances, symptoms may include:

• Pain in the pelvic area
• Pain during sexual intercourse
• Pain when urinating
• Discharge that is watery, bloody, or strong smelling
• Bleeding after intercourse or between periods
• Bleeding after menopause
• Constipation or changes in bowel function

Schedule a visit with your doctor if you have any of these symptoms. Because some symptoms may be similar to other medical conditions, it is important to rule out or diagnose cancer as soon as possible. Cancer responds best to treatment when it is done in the early stages.

Risk factors for cervical cancer

Human papillomavirus (HPV) is the most important risk factor for cervical cancer. HPV infections are very common in many young girls and women who are sexually active. In a small percentage of women, the virus can cause cells on the surface of the vagina to become cancerous. 

To reduce the risk of cervical cancer, girls and young women can receive a vaccine against HPV. 

Other risk factors can increase the chances of developing cervical cancer. However, not all women who have these risks will develop cervical cancer.

• Unprotected sex
• Sexually transmitted infections such as HIV or gonorrhea 
• Sexual activity with many partners
• Early sexual activity
• Weak immune system
• Smoking

Diagnosing cervical cancer

Screening tests 

Even before any cancer symptoms appear, screening tests can help find unusual cells that may become cancerous. The best way to find cervical cancer starts with a pelvic exam, especially when it is done on the schedule recommended by your gynecologist. 

Medical history: Your doctor will ask about your family, pregnancy, and sexual history. Please be honest and open with your doctor. We are here to help you. We are not here to make judgments.

Physical exam: The doctor may press on your abdomen to feel for lumps on the uterus and ovaries. Also, your breasts and glands may be checked for lumps.

Pelvic exam: To check for lumps, sores, or suspicious growths that may signal cancer, your doctor will examine the outside and inside of your vagina, specifically, the vulva and cervix.

Pap test: During a pelvic exam, cells from the cervix will be swabbed and sent to a lab to be examined under a microscope to look for signs of cancer, high-risk types of HPV, and abnormal cells that could develop into cancer.

Biopsies 

If the Pap test shows signs of precancerous or cancerous cells, more tests will be required, such as a colposcopy or a biopsy. 

Colposcopy: This test is similar to a pelvic exam. Your doctor will place a speculum in the vagina to see the cervix. A weak solution similar to vinegar will be applied to the cervix to make any abnormal cells easier to see. Then the doctor will use a colposcope, an instrument with a light and magnifying lens, to visually examine the cervix and vagina.

Cervical biopsy: There are several types of biopsies that diagnose cervical cancer and pre-cancer. Sometimes a biopsy can completely remove all of the abnormal tissue and it may be the only treatment required. 

• Punch biopsy: During this procedure, your doctor will use a sharp tool to pinch off small samples of tissue from the cervix.
• Colposcopic biopsy: If abnormal cells are found during the colposcopy, a small tissue sample will be removed. Sometimes a local anesthetic can be used to numb the cervix before the biopsy.
• Endocervical curettage: If certain areas of the cervix cannot be viewed with a colposcope, then a narrow instrument, called a curette, will be inserted and used to scrape a sample of tissue. The procedure may cause slight cramping or bleeding. 
• Cone biopsy or conization: During this procedure, your doctor will remove a piece of tissue that is in the shape of a cone. The cone-shape sample will contain tissue from two areas next to each other in the cervix where pre-cancers and cancers are formed. This procedure may completely remove some pre-cancers and early cancers. A cone biopsy can be done in two ways. 
  • Loop electrosurgical procedure (LEEP or LLETZ): A local anesthetic is used for this procedure. Your doctor will use a tool that has a wire loop on the end. To remove tissue in cervix, the tool is heated by an electrical current.
  • Cold knife cone biopsy: General anesthesia or epidural anesthesia (numbing medication given in the spine) is given for this procedure in the hospital. Instead of a heated wire, a surgical tool or laser is used to remove tissue in the cervix. 

If the biopsy shows that cervical cancer is present, more tests will be done to determine if the cancer cells have spread to other parts of the body. To plan the most effective treatment, it is important to know where the cancer cells have spread.

Imaging

Several different types of imaging tests may be used to look for cervical cancer. Sometimes these tests can help predict if a tumor may become cancerous. 

• Pelvic ultrasound: Images of the pelvic organs are obtained by using sound waves. A non-greasy gel is applied to the skin and a hand-held probe (transducer) is moved across the abdomen. In pregnant women, ultrasound is used to check the health of an unborn baby. In women suspected of cervical cancer, ultrasound can help diagnosis pelvic masses, fibroids, and other cervical problems. 
• Transvaginal ultrasound: This exam also uses high-energy sound waves to bounce off tissues and organs and make echoes. Then images called sonograms are obtained of the ovaries, uterus, and lining of the uterus. Either you or a sonographer will place a probe covered with a sheath and non-greasy gel in your vagina. The sonographer will move the probe to obtain the best images. You may feel some pressure. If you feel pain, tell the sonographer.
• Computed tomography (CT): Detailed and cross-sectional images of the pelvic area are made quickly with x-rays taken at various angles. It may find enlarged nodes or signs that the cancer has spread to other organs.
• Magnetic resonance imaging (MRI): Strong magnets, radio waves, and a computer are used to make detailed pictures of certain areas inside your body. The test may be able to pinpoint if cancer cells have spread to the rectum, bladder, or other organs. Before the imaging begins, a contrast dye may be injected into a vein. This painless procedure involves resting on a table and sliding into a tunnel-shaped scanner for 30-60 minutes while pictures are taken. No radiation is used.
• Positron emission tomography (PET) scan: During this painless procedure, glucose (sugar) is mixed with a very small amount of radioactive substance and injected into a vein. As you rest on a table, the solution is absorbed by certain organs and tissues. Then you will be moved into a tunnel scanner. The PET scanner traces the flow of the solution inside your body to find cancer cells which often use more glucose than normal cells.
• Colonoscopy: If you have symptoms that the cancer has moved into your colon, your doctor will want you to have a colonoscopy. You will be sedated for this procedure. A thin, flexible and lighted tube with a small video camera on the end is inserted through the anus. During the procedure, the doctor can remove any cancerous cells. 
• Barium enema x-ray: For this x-ray, liquid is inserted into your rectum through a narrow tube and then images are taken of the colon. A specially trained doctor called a radiologist will be able to see if cervical cancer has spread to the colon.
• Chest x-ray: In some cases, a chest x-ray may be required to determine if cervical cancer has spread to the chest.
• Laparoscopy: This procedure involves making a small incision in the lower abdomen and inserting a thin, lighted tube which sends images to a video monitor. This can help your doctor confirm the stage of the cancer, plan surgery, or other treatments. 

Stages of cervical cancer

Your doctor will want to find exactly where the cancer is located and how much of it is in your body. This process is called staging. For cervical cancer, the stage is determined by the physical exam, biopsies, imaging, and other tests. A specially trained physician called a pathologist will look at cells taken during the biopsy and help identify the stage of cancer. Then your gynecologist and the tumor board will determine additional treatment options. 

There are four main stages of cervical cancer. 

Stage 0: Abnormal cells in the innermost lining of the cervix may become cancerous.
Stage 1: Cancer is the cervix only. 
Stage 2: Cancer is beyond the cervix, but it is not in the pelvic wall or the lower third of the vagina.
Stage 3: Cancer is in the lower third of the vagina or the pelvic wall. The cancer may be causing problems in the kidneys. 
Stage 4: Cancer has spread past the pelvis, and it is in the lining of the bladder, rectum, or distant organs, such as the lymph nodes, lungs, liver, or bone.