How We Screen for and Diagnose Cervical Cancer

It is very important to be examined for cervical changes before there are symptoms. Screening can help the doctor find abnormal cells before cancer develops. Finding and treating these abnormal cells can prevent most cervical cancer. Also, screening can help find cancer early, when treatment is more likely to be effective.

Today, screening has a powerful new component: the ability to test for the presence of HPV. This augments the Pap smear and other methods in early detection and disease prevention.

For the past several decades, the number of women diagnosed each year with cervical cancer has been decreasing. Doctors believe this is mainly because of the success of screening.

Pap smear
Doctors recommend that women help reduce their risk of cervical cancer by having regular Pap tests. A Pap test (sometimes called Pap smear or cervical smear) is a simple test used to look at cervical cells. For most women, the test is not painful. A Pap test is done in a doctor's office or clinic during a pelvic exam. The doctor or nurse scrapes a small sample of cells from the cervix. A lab checks the cells on the slides under a microscope for abnormalities.

Pap tests can find cervical cancer or abnormal cells that can lead to cervical cancer.

Doctors generally recommend that women:
  • begin having Pap tests three years after they begin having sexual intercourse, or when they reach age 21 (whichever comes first).
  • should have a Pap test at least once every three years.
  • aged 65 to 70 who have had at least three normal Pap tests and no abnormal Pap tests in the past 10 years may decide, after speaking with their doctor, to stop cervical cancer screening.
  • who have had a hysterectomy to remove the uterus and cervix, also called a total hysterectomy, do not need to have cervical cancer screening. However, if the surgery was treatment for precancerous cells or cancer, the woman should continue with screening.
Women should talk with their doctor about when they should begin having Pap tests, how frequently and when they can stop having them. This is especially important for women at higher-than-average risk of cervical cancer.

Some activities can hide abnormal cells and affect Pap test results. Doctors suggest the following tips:
  • Do not douche for 48 hours before the test
  • Do not have sexual intercourse for 48 hours before the test
  • Do not use vaginal medicines (except as directed by a doctor) or birth control foams, creams or jellies for 48 hours before the testDoctors also suggest that a woman schedule her Pap test for a time that is 10 to 20 days after the first day of her menstrual period.
Most often, abnormal cells found by a Pap test are not cancerous. However, some abnormal conditions may develop into cancer over time:
  • Low-grade squamous intraepithelial lesion (LSIL):
    LSILs are mild cell changes on the surface of the cervix. Such changes often are caused by HPV infections. LSILs are common, especially in young women, yet are are not cancer. Even without treatment, most LSILs stay the same or go away. However, some turn into high-grade lesions, which may lead to cancer.
  • High-grade squamous intraepithelial lesion (HSIL):
    HSILs are not cancer, but without treatment they may lead to cancer. The precancerous cells are only on the surface of the cervix. They look very different from normal cells.
HPV Test
The HPV test is usually performed at the same time as a Pap smear, and analyzes the DNA of cervical cells for the presence of HPV. It is usually performed in women 30 or older.
A positive HPV test result only indicates the presence of the virus; it does not mean the woman has cervical cancer. A positive HPV test result signals a doctor to examine the Pap smear for any precancerous changes. A colposcopy and/or biopsy may then be ordered to detect abnormal cervical cells.
Diagnosing Cervical Cancer
If a woman has a symptom or Pap test results that suggest precancerous cells or cancer of the cervix, and/or her HPV test is positive, her doctor will suggest other procedures to make a diagnosis.

These may include:
  • Colposcopy: The doctor uses a colposcope, which combines a bright light with a magnifying lens to make tissue easier to see, to examine the cervix. It is not inserted into the vagina. A colposcopy is usually done in the doctor's office or clinic.
  • Biopsy: The doctor removes tissue to look for precancerous cells or cancer cells. Most women have their biopsy in the doctor's office with local anesthesia. A pathologist checks the tissue with a microscope.
  • Punch biopsy: The doctor uses a sharp, hollow device to pinch off small samples of cervical tissue.
  • Loop electrosurgical excision procedure: The doctor uses an electric wire loop to extract a thin, round piece of tissue.
  • Endocervical curettage: The doctor uses a curette (a small, spoon-shaped instrument) to scrape a small sample of tissue from the cervical canal. Some doctors may use a thin, soft brush instead of a curette.
  • Conization (Cone biopsy): The doctor removes a cone-shaped sample of tissue. A conization, or cone biopsy, lets the pathologist see if abnormal cells are in the tissue beneath the surface of the cervix. The doctor may do this test in the hospital under general anesthesia. Conization also may be used to remove a precancerous area.
  • Removing tissue from the cervix may cause some bleeding or other discharge. The area usually heals quickly. Women may also feel some pain similar to menstrual cramps. Medicine can relieve this discomfort.
If the biopsy shows that you have cancer, your doctor will do a thorough pelvic exam and may remove additional tissue to learn the extent (stage) of your disease. The stage tells whether the tumor has invaded nearby tissues, whether the cancer has spread and, if so, to what parts of the body.

These are the stages of cervical cancer:
  • Stage 0: The cancer is found only in the top layer of cells in the tissue that lines the cervix. Stage 0 is also called carcinoma in situ.
  • Stage I: The cancer has invaded the cervix beneath the top layer of cells. It is found only in the cervix.
  • Stage II: The cancer extends beyond the cervix into nearby tissues. It extends to the upper part of the vagina. The cancer does not invade the lower third of the vagina or the pelvic wall (the lining of the part of the body between the hips).
  • Stage III: The cancer extends to the lower part of the vagina. It also may have spread to the pelvic wall and nearby lymph nodes.
  • Stage IV: The cancer has spread to the bladder, rectum or other parts of the body. Recurrent cancer:The cancer was treated, but has returned after a period of time during which it could not be detected. The cancer may show up again in the cervix or in other parts of the body.

To learn the extent of disease and suggest a course of treatment, the doctor may order some of the following tests:
  • Chest X-rays: X-rays often can show whether cancer has spread to the lungs.
  • Computed tomography (CT) scan: An X-ray machine linked to a computer takes a series of detailed pictures of your organs. You may receive contrast material by injection in your arm or hand, by mouth or by enema. (Some people are allergic to contrast materials that contain iodine. Tell your doctor or nurse if you have allergies.) The contrast material makes abnormal areas easier to see. A tumor in the liver, lungs or elsewhere in the body can show up on the CT scan.
  • Magentic resonance imagine (MRI): A powerful magnet linked to a computer is used to make detailed pictures of your pelvis and abdomen. The doctor can view these pictures on a monitor and can print them on film. An MRI can show whether cancer has spread. Sometimes contrast material makes abnormal areas show up more clearly on the picture.
  • Ultrasound: An ultrasound device is held against the abdomen or inserted into the vagina. The device sends out sound waves that people cannot hear. The waves bounce off the cervix and nearby tissues, and a computer uses the echoes to create a picture. Tumors may produce echoes that are different from the echoes made by healthy tissues. The picture can show whether cancer has spread.