Cervical Cancer Tests

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How Is Cervical Cancer Diagnosed?

The cervix viewed from below shows spreading cancer on the cervix between the vagina and the uterus

Many women don't have symptoms of cervical cancer. A health care provider may first see signs of cancer during a pelvic exam or a Pap test.

If your health care provider thinks you might have cervical cancer, certain exams and tests will need to be done to be sure. Diagnosing cervical cancer starts with your health care provider asking you questions. You will be asked about your medical history, your symptoms, risk factors, and family history of disease. Your health care provider will also give you a physical exam. You will likely need to have some tests to find out what has caused the changes in your cervix.

You may have one or more of the following tests:

  • Pelvic exam
  • Pap and HPV tests
  • Colposcopy
  • Biopsy

Pelvic exam

Your doctor or health care provider does a pelvic exam in his or her office. This exam is recommended as a part of regular cancer screening for women. To have the exam, you need to remove your clothes from the waist down and put on a medical gown. You lie on your back on an exam table, bend your knees, and then place your feet in supports called stirrups at the end of the table. This position allows the doctor to look at or feel your cervix, uterus, vagina, ovaries, fallopian tubes, bladder, and rectum. The doctor places a plastic or metal tool called a speculum inside your vagina. This lets the doctor see the upper portion of your vagina and your cervix. After removing the speculum, the doctor inserts two or three gloved fingers into your vagina and uses his or her other hand to press on your abdomen. This is to feel other organs and check for lumps (masses) or anything unusual.

Some cervical cancer may be found during a pelvic exam. While your doctor can’t see precancer changes such as dysplasia, he or she may see some invasive cancer during an exam. If something suspicious is seen during the pelvic exam, more tests can help see if you have cervical cancer.

Pap and HPV tests

A Pap test is the standard way to see if there are any cervical cell changes that cause concern. An HPV test shows if you have an infection with the types of HPV that are known to be linked to cervical cancer.

Both tests can be done in the doctor's office during a pelvic exam. The HPV and Pap tests may feel uncomfortable, but they should not hurt, and it takes just seconds to do them. The doctor uses a speculum to widen your vagina and examine the upper part of your vagina and cervix. This is the area that connects your vagina to your uterus. The doctor then uses a small, soft brush to collect cells from the cervix and vagina. A specialized doctor called a pathologist looks at the cells under a microscope in a lab to check for cancer and HPV infection.

Colposcopy

This procedure is used to allow the health care provider to look very closely at your cervix using a magnifying tool called a colposcope. It can help pinpoint abnormal areas in the cervix. A speculum is used, like during a pelvic exam, so the cervix can be seen. The doctor looks at it through the colposcope, which stays outside your body. Cells from areas that look different from the normal cervix cells may be removed to be examined in the lab. This is called a biopsy.

Biopsy

There are different ways to do a cervical biopsy. All are done by removing tissue to be examined under a microscope. Endocervical curettage is a biopsy where a small spoon-like tool is used to scrape cells or tissue from the part of the cervix that is closest to the uterus (cervical canal). This may be done during colposcopy. There are other procedures used to collect larger pieces of tissue from the cervix. This may be called a cone biopsy, and a laser or wire may be used to remove the tissue. You may be given medicines to put you in a deep sleep and not feel pain. Or the cervix may be numbed during these types of biopsy. A biopsy may cause some bleeding or other discharge. The area usually heals quickly. Some women also feel some pain similar to menstrual cramps. 

When your health care provider has the results of your biopsy, he or she will contact you with the results. Your provider will talk with you about other tests you may need if cervical cancer is found. Make sure you understand the results and what follow-up you need.

What Are The Screening Guidelines For Cervical Cancer?

A Pap test can find precancerous cells of the cervix before they become cancer. Having regular Pap tests gives you a better chance of preventing cancer. In fact, most cases of cervical cancer are found in women who have not had regular screening tests.

The American Cancer Society (ACS) notes that all women should get regular Pap tests starting at age 21. The ACS recommendations say that: 

Women between ages 21 and 29 should get a Pap test done every three years.

  • Women between the ages of 30 and 65 should have a Pap test plus an HPV test (co-testing) every five years.
  • Women older than 65 who have had regular screening with normal results should not be screened for cervical cancer. Once screening is stopped, it should not be started again.
  • Women who have an increased risk for cervical cancer because of a weak immune system or other risk factors may need screening more often and should talk with their health care provider. 
  • A woman who has had a hysterectomy with removal of the cervix for reasons not related to cervical cancer and who has no history of cervical cancer or serious precancer should not be screened.  
  • A woman who has been vaccinated against HPV should follow the screening advice for her age group.