Diagnosis of cervical cancer

Usually, diagnosing cervical cancer begins when a Pap test becomes abnormal. Your doctor will ask you about any symptoms you have and may do a physical exam. Based on this information, your doctor will refer you to a specialist or order tests to check for cervical cancer or other health problems.

The process of diagnosis may seem long and frustrating. It’s normal to worry, but try to remember that other health conditions can cause similar symptoms as cervical cancer. It’s important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of cervical cancer.

The following tests are usually used to rule out or diagnose cervical cancer. Many of the same tests used to diagnose cancer are used to find out the stage (how far the cancer has spread). Your doctor may also order other tests to check your general health and to help plan your treatment.

Your health history is a record of your symptoms, risk factors and all the medical events and problems you have had in the past. Your doctor will ask questions about your history of:

• symptoms that suggest cervical cancer
• sexual activity
• abnormal Pap tests and treatments
• smoking

A physical exam allows your doctor to look for any signs of cervical cancer. During a physical exam, your doctor may:

• do a Pap test and a pelvic exam
• do a digital rectal exam (DRE) to feel for any abnormal changes
• feel the lymph nodes in the groin and above the collarbone to see if they are swollen

Find out more about physical exams, a pelvic exam and a digital rectal exam (DRE).

A Pap test removes a small sample of cells from the surface of the cervix. Doctors look at the cells under a microscope to see if they look normal or abnormal. The test can find abnormal changes in cells early, before cancer develops.

A Pap test is used to screen for cervical cancer. It is done every 1 to 3 years, depending on your province’s or territory’s screening guidelines and your health history.

Find out more about a Pap test.

A human papillomavirus (HPV) test is a lab test that looks for the DNA of only high-risk types of HPV that have been linked to cervical cancer. In some cases, the HPV test can be done on the same sample of cells collected during a Pap test.

Find out more about an HPV test.

A colposcopy uses a colposcope (a lighted magnifying instrument) to examine the vulva, vagina and cervix.

A colposcopy is done after an abnormal Pap test or a positive HPV test suggests a precancerous condition of the cervix or cervical cancer. A colposcopy may also be done if you have symptoms of cervical cancer.

A colposcopy is done in much the same way as a Pap test. The doctor places a speculum in the vagina. The speculum is a plastic or metal device that separates the walls of the vagina so the doctor can clearly see the cervix. The doctor may swab the area with a solution that helps the lining of the cervix show up better. The doctor then uses a colposcope to carefully examine the inside surface of the cervix and the vagina. The colposcope is positioned outside the opening of the vagina, rather than inserted into the vagina. The doctor may do a biopsy during a colposcopy if there is an abnormal area on the cervix.

It is better to have a colposcopy when you aren’t menstruating. For 48 hours before the test, avoid sexual intercourse, vaginal douches, vaginal medicines and contraceptive (spermicidal) creams, foams and gels (except as directed by your doctor). These should be avoided because they can interfere with the procedure and may affect the test results.

A pregnant woman can have a colposcopy if her doctor recommends it.

If a Pap test returns abnormal results, your doctor will likely need to take a biopsy from the cervix. During a biopsy, the doctor removes tissues or cells from the body so they can be looked at under a microscope to see if cancer cells are present in the sample.

The following biopsies may be used to sample cells and tissue from the cervix or nearby areas. Find out more about a biopsy.

A colposcopic biopsy is done during a colposcopy. A local anesthetic (freezing) may be used to numb the cervix. The doctor uses biopsy forceps to remove small amounts of tissue from suspicious-looking areas in the cervix or vagina.

An endocervical curettage is done during a colposcopy. A local anesthetic may be used to numb the cervix. The doctor uses a curette to gently scrape cells and tissue from the endocervical canal. A curette is a narrow, spoon-shaped tool.

An endometrial biopsy uses a special tool, called a pipelle, to remove cells from the lining of the inside of the uterus (called the endometrium) so they can be examined under a microscope to check for cancer. It can be done during a colposcopy.

A cone biopsy removes a cone-shaped piece of tissue from the cervix. The cone is formed by removing the outer part of the cervix closest to the vagina and part of the endocervical canal.

Depending on the way the cone biopsy is done, it may be done during a colposcopy or as a separate procedure in an operating room. A cone biopsy may be all the treatment you need for a precancerous condition of the cervix.

Find out more about a cone biopsy.

A sentinel lymph node biopsy (SLNB) removes the sentinel lymph node to see if it contains cancer. The sentinel lymph node is the first in a chain or cluster of lymph nodes that receives lymph fluid from the area around a tumour. If cancer cells spread, they will most likely spread to these lymph nodes first. There may be more than one sentinel node, depending on the drainage route of the lymph vessels around the tumour.

Learn more about a sentinel lymph node biopsy (SLNB).

A CBC measures the number and quality of white blood cells, red blood cells and platelets. A CBC may be done to check for anemia from long-term, or chronic, vaginal bleeding. A CBC also gives doctors a baseline to compare future blood tests to during and after treatment.

Find out more about a complete blood count (CBC)..

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are working and can help find abnormalities.

Blood chemistry tests are done to check how well the kidneys and liver are working as part of the diagnosis process for cervical cancer. They also help determine if these organs are healthy enough to cope with and recover from the effects of cancer treatments.

Find out more about blood chemistry tests.

An endoscopy allows a doctor to look inside body cavities using a flexible tube with a light and lens on the end (an endoscope).

A cystoscopy uses an endoscope (called a cystoscope) to examine the bladder and urethra. It is done to find out if the cancer has spread to these organs. Doctors can do a biopsy at the same time as a cystoscopy if they find a suspicious area during the exam.

A sigmoidoscopy uses an endoscope (called a sigmoidoscope) to examine the sigmoid colon (the last part of the colon) and the rectum. It is done to find out if the cancer has spread to the rectum. Doctors can do a biopsy at the same time as a sigmoidoscopy if they find a suspicious area during the exam.

Find out more a cystoscopy and a sigmoidoscopy.

An x-ray uses small doses of radiation to make an image of parts of the body on film. A chest x-ray is used to see if cancer has spread to the lungs.

Find out more about x-rays.

A barium enema is an x-ray that uses a special dye (contrast medium) called barium sulphate. It is used to check if cancer has spread to the colon or rectum.

Find out more about a barium enema.

A computed tomography (CT) scan uses special x-ray equipment to make 3D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.

A CT scan is used to:

• assess the pelvis, abdomen and lymph nodes around the cervix
• see if cancer has spread to other organs or tissues
• guide the needle when doing a biopsy of an area of suspected metastasis

Find out more about CT scans.

Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3D pictures.

An MRI is used to:

• assess the pelvis, abdomen and lymph nodes around the cervix
• see if cancer has spread to other organs or tissues
• guide the needle when doing a biopsy of an area of suspected metastasis

Find out more about MRIs.

An intravenous pyelogram (IVP) is a special x-ray of the urinary system. It may be used to see if cancer is blocking the ureters (tubes that connect the kidneys to the bladder). An IVP may not be needed if a CT scan or an MRI has been done.

Find out more about an intravenous pyelogram (IVP).

A positron emission tomography (PET) scan uses radioactive materials called radiopharmaceuticals to look for changes in the metabolic activity of body tissues. A computer analyzes the radioactive patterns and makes 3D colour images of the area being scanned. It may be combined with a CT scan, called a PET-CT scan.

A PET scan may be used to find cervical cancer that has come back or has spread to other organs or tissues.

Find out more about PET scans.

To make the decisions that are right for you, ask your healthcare team questions about a diagnosis.