Medical history and physical exam
A medical history is a record of your symptoms, risk factors, and your personal and familial medical history. When looking for cervical cancer, your doctor will may ask about symptoms that suggest cervical cancer, your sexual history, if you smoke, any abnormal pap tests and treatments, and if there isa family history of cervical cancer.
A physical exam allows your doctor to look for any signs of cervical cancer. During a physical exam, your doctor may perform a Pap test (if it has not already been done), a pelvic exam, or a digital rectal exam (DRE) to feel for a lump or thickened area or around the lymph nodes in the groin and above the collarbone to see if they are swollen.
Tests for symptoms of cervical cancer or abnormal Pap results
Colposcopy
If you have symptoms that suggest cancer or if your Pap test shows abnormal cells, you will need to have a test called a colposcopy. You will lie on the exam table and a speculum will be placed in the vagina to help the doctor see the cervix. The doctor will then use a colposcope to closely examine the surface of the cervix.
Cervical biopsies
Several types of biopsies can be used to diagnose cervical pre-cancers and cancers. If the biopsy can completely remove all of the abnormal tissue, it may be the only treatment needed.
Colposcopic biopsy — The cervix is first examined with a colposcope to find the abnormal areas. Using a biopsy forceps, a small (about 1/8-inch) section of the abnormal area on the surface of the cervix is removed.
Endocervical curettage (endocervical scraping) — Sometimes the transformation zone (the area at risk for HPV infection and pre-cancer) cannot be seen by the colposcope. Instead, a scraping of tissue from the endocervix is taken by inserting a narrow instrument (called a curette) into the endocervical canal (the part of the cervix closest to the uterus).
Cone biopsy —The doctor removes a cone-shaped piece of tissue from the cervix. The base of the cone is formed by the exocervix (outer part of the cervix), and the point or apex of the cone is from the endocervical canal. The tissue removed in the cone includes the transformation zone (the border between the exocervix and endocervix, where precancerous l lesions and cancers are most likely to start). A cone biopsy can also be used as a treatment to remove precancerous lesions and some very early cancers.
The methods commonly used for cone biopsies are the loop electrosurgical excision procedure (LEEP), also called the large loop excision of the transformation zone (LLETZ), and the cold knife cone biopsy.
- Loop electrosurgical procedure (LEEP, LLETZ): The tissue is removed with a thin wire loop that is heated by electrical current and acts as a scalpel.
- Cold knife cone biopsy: This method uses a surgical scalpel or a laser instead of a heated wire to remove tissue.
If a cancer is found on a biopsy, it will be identified as either squamous cell carcinoma or adenocarcinoma.
Diagnostic tests for women with cervical cancer
If a biopsy shows that cancer is present, your doctor may order certain tests to see how far the cancer has spread. Many of the tests described below are not necessary for every patient. Decisions about using these tests are based on the results of the physical exam and biopsy. These are most often done in women who have large tumors. They are not necessary if the cancer is caught early.
Cystoscopy — A slender tube with a lens and a light is placed into the bladder through the urethra. This lets the doctor check your bladder and urethra to see if cancer is growing into these areas. Biopsy samples can be removed during cystoscopy for pathologic (microscopic) testing.
Proctoscopy — A visual inspection of the rectum through a lighted tube to check for spread of cervical cancer into your rectum.
Your doctor may also do a pelvic exam while you are under anesthesia to find out if the cancer has spread beyond the cervix.
Imaging studies
If your doctor finds that you have cervical cancer, certain imaging studies may be done. These include magnetic resonance imaging (MRI) and computed tomography (CT) scans. These studies can show whether the cancer has spread beyond the cervix.
Chest x-ray — Your chest may be x-rayed to see if the cervical cancer has spread to your lungs, however, this is very unlikely unless the cancer is far advanced.
Computed tomography (CT)
The computed tomography (CT) scan is an x-ray procedure that produces detailed cross-sectional images of your body. Unlike a conventional x-ray, a CT scanner takes many pictures as it rotates around your body. A computer then combines these pictures into an image of a slice of your body (think of a loaf of sliced bread). The machine takes pictures of multiple slices of the part of your body that is being studied. CT scans can help tell if your cancer has spread to the lymph nodes in the abdomen and pelvis. They can also be used to see if the cancer has spread to elsewhere in the body. CT scans are sometimes used to guide a biopsy needle precisely into an area of suspected cancer spread, this is called a CT-guided needle biopsy.
Magnetic resonance imaging (MRI)
Magnetic resonance imaging (MRI) scans use radio waves and strong magnets instead of x-rays to take pictures. Not only does this produce cross sectional slices of the body like a CT scanner, it can also produce slices that are parallel with 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.
Intravenous urography
Intravenous urography (also known as intravenous pyelogram, or IVP) is an x-ray of the urinary system taken after a special dye is injected into a vein. This dye is removed from the bloodstream by the kidneys and passes through the ureters and into the bladder (the ureters are the tubes that connect the kidneys to the bladder). This test finds abnormalities in the urinary tract, such as changes caused by spread of cervical cancer to the pelvic lymph nodes, which may compress or block a ureter. IVP is rarely used currently to evaluate patients with cervical cancer.
Positron emission tomography
Positron emission tomography (PET) scans uses glucose (a form of sugar) that contains a radioactive atom. Cancer cells in the body absorb large amounts of the radioactive sugar and a special camera can detect the radioactivity. This test can help see if the cancer has spread to lymph nodes. PET scans can also be useful if your doctor thinks the cancer has spread but doesn’t know where.
For more information on these diagnostic tests, please visit the American Cancer Society.
[30] Pelvic Exam With Speculum. Digital image. WebMD. Healthwise, 12 Mar. 2014. Web. 05 Jan. 2016.
[31] Information taken from the American Cancer Society