Cervical Cancer Diagnosis Methods: A Comprehensive Guide

Hello. I’m Dr. Kristina Butler, a gynecologic oncologist at Mayo Clinic, and I’m here to provide you with a detailed overview of the diagnosis methods for cervical cancer. Early and accurate diagnosis is crucial in managing cervical cancer effectively. This article will explore the various screening and diagnostic procedures available, helping you understand the process and empowering you to take proactive steps for your health.

Cervical cancer diagnosis often begins with screening tests designed to detect precancerous changes and early-stage cancer. These screening methods are vital as they can identify abnormalities before they progress into invasive cancer. Let’s delve into the primary screening methods:

Cervical Cancer Screening: Pap Test and HPV Test

Regular cervical cancer screening is a cornerstone of preventive healthcare. The two main screening tests are the Pap test and the Human Papillomavirus (HPV) test.

Pap Test

The Pap test, also known as a Pap smear, is a procedure used to collect cells from the cervix – the lower, narrow end of the uterus that is at the top of the vagina. This test aims to find precancerous and cancerous cells that could develop into cervical cancer.

During a Pap test, a speculum is gently inserted into the vagina to widen it, allowing the cervix to be visible. A soft brush and a spatula are then used to carefully collect cells from the surface of the cervix and the endocervical canal (the opening of the cervix leading into the uterus). These collected cells are placed in a liquid preservative and sent to a laboratory for examination under a microscope.

The laboratory analysis checks for any abnormalities in the cervical cells. An abnormal Pap smear result doesn’t automatically mean you have cervical cancer. In fact, abnormal results are quite common and often indicate the presence of precancerous changes, inflammation, or an infection like HPV. Most women with abnormal Pap smears do not develop cervical cancer. However, an abnormal result necessitates further investigation to rule out cancer or precancerous conditions.

Recommendations for Pap smear frequency vary by age and risk factors, but generally, screening begins at age 21 and is repeated every three to five years.

HPV DNA Test

The HPV test is another crucial screening tool used in cervical cancer prevention. This test detects the presence of Human Papillomavirus (HPV), a common virus that can cause cell changes in the cervix that may lead to cancer. Certain types of HPV are considered high-risk because they are more strongly linked to cervical cancer.

The HPV test is often performed using the same cervical cell sample collected during a Pap test. The lab analyzes the sample to determine if high-risk HPV types are present. The HPV test can be done alone or in conjunction with a Pap test (co-testing).

The HPV vaccine is highly effective in preventing infection from the HPV types most commonly associated with cervical cancer and is recommended for both females and males. Even if you have already been exposed to HPV or have had precancerous cervical changes, the HPV vaccine can still provide benefit by protecting against other high-risk HPV types. Vaccination is now recommended for adults up to age 45, expanding the age range from previous guidelines.

Diagnostic Procedures Following Abnormal Screening Results

If a Pap test or HPV test result is abnormal, further diagnostic procedures are needed to determine the cause and rule out cervical cancer. These procedures are more in-depth and aim to get a clearer picture of the cervical cells and tissues.

Colposcopy

Colposcopy is a procedure often recommended after an abnormal Pap smear result. It involves using a colposcope, a special magnifying instrument with a bright light, to closely examine the cervix, vagina, and vulva. The colposcope allows the doctor to visualize the tissues at a higher magnification, identifying any abnormal areas that were indicated by the Pap test.

During a colposcopy, the doctor may apply a solution, such as acetic acid (vinegar) or iodine, to the cervix. These solutions help highlight abnormal cells, making them more visible under the colposcope. Areas that appear abnormal can then be targeted for biopsy. Colposcopy itself is usually not painful, although you might feel some pressure when the speculum is inserted.

Cervical Biopsy

If abnormal areas are identified during a colposcopy, a biopsy is typically performed. A cervical biopsy involves taking a small tissue sample from the cervix for microscopic examination by a pathologist. There are different types of cervical biopsies:

Punch Biopsy: This technique uses a sharp, punch-like tool to remove small, cylindrical pieces of tissue from the abnormal areas identified during colposcopy. Several punch biopsies may be taken from different suspicious areas.
Endocervical Curettage (ECC): If abnormalities are suspected in the endocervical canal (which is not easily visible during colposcopy), an endocervical curettage may be performed. This involves using a small, spoon-shaped instrument called a curette or a thin brush to gently scrape tissue from the endocervical canal.
Loop Electrosurgical Excision Procedure (LEEP): LEEP, also known as large loop excision of the transformation zone (LLETZ), uses a thin, low-voltage electrified wire loop to remove abnormal tissue from the cervix. LEEP can be used for both diagnostic and therapeutic purposes. It removes a larger area of tissue than punch biopsies, and the removed tissue can be examined to confirm the diagnosis and ensure all abnormal cells have been removed. LEEP is usually performed in a doctor’s office under local anesthesia to numb the cervix.
Cone Biopsy (Conization):

Cone biopsy, or conization, is a surgical procedure that removes a cone-shaped wedge of tissue from the cervix. This procedure allows for a deeper and larger tissue sample to be obtained compared to other biopsy methods. A cone biopsy is usually performed when precancerous changes are high-grade, when there is a discrepancy between Pap smear results and biopsy results, or when cancer is suspected to be invasive.

Cone biopsies can be performed using a LEEP, a cold knife (surgical scalpel), or a laser. It is typically done in a hospital or surgical center. Anesthesia options can include local anesthesia, regional anesthesia (spinal or epidural), or general anesthesia, depending on the method used and the patient’s health status. A cone biopsy provides a larger tissue sample for thorough pathological examination and can also be used as a treatment to remove precancerous or early-stage cancerous tissue completely.

Cervical Cancer Staging

If cervical cancer is diagnosed, staging is the next critical step. Staging determines the extent of the cancer, including its size, location, and whether it has spread to nearby tissues or distant parts of the body. Staging is essential for planning the most appropriate treatment and predicting prognosis.

Staging Tests

Cervical cancer staging may involve various tests, including:

Pelvic Exam: A thorough physical examination, including a pelvic exam, is performed to assess the extent of the tumor and involvement of surrounding tissues.
Imaging Tests: Imaging techniques provide detailed pictures of the inside of the body and help determine if the cancer has spread. Common imaging tests used in cervical cancer staging include:
- X-ray: To check for lung metastasis.
- Computed Tomography (CT) Scan: Provides cross-sectional images of the body to assess the size and spread of the tumor to lymph nodes and other organs.
- Magnetic Resonance Imaging (MRI): Offers detailed images of soft tissues and is particularly useful for assessing local spread of cervical cancer in the pelvis.
- Positron Emission Tomography (PET) Scan: Often combined with CT (PET/CT scan), PET scans can detect metabolically active cancer cells throughout the body, helping to identify distant metastases.
Examination of Bladder and Rectum: In some cases, cystoscopy (examination of the bladder using a scope) and proctoscopy or sigmoidoscopy (examination of the rectum and lower colon using a scope) may be performed to check if the cancer has spread to these adjacent organs.

Stages of Cervical Cancer

Cervical cancer is staged using the FIGO (International Federation of Gynecology and Obstetrics) staging system, which ranges from Stage 0 to Stage IV. The stage is based on the size and extent of the tumor and whether it has spread to lymph nodes or distant sites.

Stage 0 (Carcinoma in situ): Precancerous cells are present only in the surface layer of the cervix.
Stage I: Cancer is confined to the cervix.
Stage II: Cancer has spread beyond the cervix but not to the pelvic wall or the lower part of the vagina.
Stage III: Cancer has spread to the pelvic wall and/or the lower part of the vagina, and/or has caused kidney problems due to blockage of the ureters.
Stage IV: Cancer has spread beyond the pelvis or to distant organs (metastasis). Stage IV is further divided into IVA (spread to bladder or rectum) and Stage IVB (distant metastasis).

Early-stage cervical cancer (Stage I and some Stage II) generally has a better prognosis and more treatment options available, including fertility-sparing treatments in some cases. Early detection through regular screening and prompt diagnosis significantly improves outcomes for women with cervical cancer.

Conclusion

Diagnosing cervical cancer involves a series of steps, starting with screening tests like Pap tests and HPV tests. Abnormal results lead to further diagnostic procedures such as colposcopy and biopsies, including punch biopsy, endocervical curettage, LEEP, and cone biopsy. If cancer is diagnosed, staging is performed to determine the extent of the disease. Understanding these Cervical Cancer Diagnosis Methods empowers you to engage in informed discussions with your healthcare provider, ensuring timely screening and appropriate follow-up for optimal health outcomes. If you have any concerns or questions about cervical cancer screening or diagnosis, please consult with your medical team. Early detection and proactive care are your best defenses against cervical cancer.

Request an appointment

References

Cervical cancer. Cancer.Net. https://www.cancer.net/cancer-types/cervical-cancer/view-all. Accessed March 27, 2023.
Gershenson DM, et al. Malignant diseases of the cervix. In: Comprehensive Gynecology. 8th ed. Elsevier; 2022. https://www.clinicalkey.com. Accessed March 27, 2023.
Niederhuber JE, et al., eds. Cancers of the cervix, vulva and vagina. In: Abeloff’s Clinical Oncology. 6th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed March 27, 2023.
Cervical cancer. National Comprehensive Cancer Network. ps://www.nccn.org/guidelines/guidelines-detail?category=1&id=1426. Accessed March 27, 2023.
AskMayoExpert. Cervical cancer screening (adult). Mayo Clinic; 2022.
Palliative care. National Comprehensive Cancer Network. https://www.nccn.org/guidelines/guidelines-detail?category=3&id=1454. Accessed March 27, 2023.
What is cervical cancer? National Cancer Institute. https://www.cancer.gov/types/cervical. Accessed March 27, 2023.