Diagnosis of Cervical Cancer
Diagnosing cervical cancer includes performing a pelvic examination and a Papanicolaou test (Pap smear). In women who are over the age of 30, cervical cancer screening also involves a test to detect high-risk HPV infection (called the digene HPV test). An HPV test also may be performed in women younger than 30 years of age who have an inconclusive Pap smear.
The American Cancer Society recommends that all women begin having annual Pap smears at the age of 18, or when they become sexually active. After three consecutive negative tests, health care practitioners may perform the test less often (e.g., every 2 or 3 years). The American College of Obstetrics and Gynecology recommends a yearly Pap smear for all women who are sexually active.
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)
