Diagnosis of Cervical Cancer
Cervical cancer screening guidelines include the following:
- In most women, screening should begin at the age of 21.
- Between the ages of 21 and 29, women should have a Pap test every 3 years.
- Women aged 30 - 65 should have a Pap test and HPV test every 5 years or a Pap test every 3 years.
- Women should discontinue cervical cancer screening after the age of 65 if they do not have a history of moderate/severe cervical dysplasia or cancer and they have had 3 consecutive negative Pap tests or 2 consecutive Pap tests/HPV tests within the past 10 years and the most recent test was within 5 years.
These guidelines do not apply to women who have a history of cervical cancer, women with HIV/AIDS, women who have a weakened immune system, and women who were exposed to the drug DES (diethylstilbestrol) before birth. Women who have had an abnormal cervical cancer screening result and those who have had a hysterectomy should talk to their health care provider about testing recommendations.
According to the Centers for Disease Control and Prevention (CDC) in November 2014, approximately 8 million women between the ages of 21 and 65 in the United States did not receive the recommended cervical cancer screening from 2007 through 20011. The CDC reports that more than 50 percent of new cervical cancer cases occur in women who have rarely or never been screened for the disease.
In a pelvic examination, the vagina and adjacent organs are examined visually and bimanually (using both hands). Visual examination is performed using a speculum (instrument that is warmed and used to separate tissue) inserted into the vagina. Next, the pelvic organs are palpated (felt with the fingers) by inserting gloved fingers of one hand into the vagina and placing the other hand on the abdomen.
In a Pap smear, the health care practitioner removes cells from the surface of the cervix (lower portion of the uterus) using a spatula, cotton swab, or brush. The cells are placed on a glass slide for microscopic evaluation in a laboratory. For accurate results, the test should be performed 2 weeks after the end of a menstrual period and at least 48 hours after sexual intercourse.
If cervical lesions are suspected or high-risk HPV infection is present, a procedure called colposcopy is performed. In colpscopy, the cervix is washed with a diluted vinegar solution and examined for abnormalities using a light and a magnifying device (colposcope). If abnormal areas are detected, further evaluation is necessary, regardless of the results of the Pap smear.
If low-grade CIN is detected, the Pap smear is repeated in 3 - 6 months and the woman is tested for HPV infection. If high-grade CIN is detected, colposcopy and biopsy may be performed. In a biopsy, cells are removed from the cervix and are examined under a microscope.
If invasive cervical cancer is suspected, or if the colpscopy and Pap smear results differ, cone biopsy or endocervical curettage may be performed. In cone biopsy, a larger, cone-shaped sample of cervical tissue is removed and examined for cancer cells. In endocervical curettage, the lining of the cervical canal is scraped and examined for cancer cells.
Once a diagnosis of cervical cancer is made, the cancer is staged. Cervical cancer staging involves a pelvic examination, blood tests, and imaging procedures. Blood tests may include a complete blood count (CBC) and serum chemistry to evaluate kidney and liver function.
Imaging procedures may include the following:
- Chest x-ray (to detect lung metastasis)
- CT scan of the pelvis and abdomen (to detect metastasis to the liver, lymph nodes, and other organs)
- Cystoscopy and proctoscopy (to detect metastasis to the bladder or colon)