Cervical Cancer: Diagnosis
How is cervical cancer diagnosed?
Many women don't have symptoms of cervical cancer. A healthcare provider may first find signs of cancer during a pelvic exam or a Pap test.
If your healthcare provider thinks you might have cervical cancer, you will need certain exams and tests to be sure. Diagnosing cervical cancer starts with your healthcare provider asking you questions. You will be asked about your health history, your symptoms, risk factors, and family history of disease. Your healthcare provider will also give you a physical exam.
What tests might I need?
You may have 1 or more of the following tests:
Pap and HPV tests
Your doctor or healthcare provider does a pelvic exam in his or her office. To have the exam, you'll 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 provider 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 1 or 2 gloved fingers into your vagina. He or she uses the other hand to press on your belly (abdomen). This is to feel other organs and check for lumps (masses) or anything unusual.
Your doctor may also do a recto-vaginal exam. The doctor places 1 finger in your rectum and the other finger in your vagina. This is to feel the tissue between and around these 2 organs.
Some cervical cancer may be found during a pelvic exam. Your provider can’t see precancer changes such as dysplasia. But the provider may see some invasive cancer during an exam. If something suspicious is seen during the pelvic exam, more tests will be needed.
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 shouldn’t hurt. It takes just seconds to do them. The doctor uses a tool called a speculum to widen your vagina and examine the upper part of your vagina and cervix. 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. This is done to check for precancer, cancer, and HPV infection.
This procedure lets the healthcare provider look very closely at your cervix using a lighted magnifying tool called a colposcope. It can help find abnormal areas in the cervix. First a tool called a speculum (used in Pap tests) is placed in the vagina to help the doctor see the cervix. Then the doctor looks closely at your cervix through the colposcope, which stays outside your body. Cells from areas that look different from the normal cervix cells may be removed and checked in the lab. This is called a biopsy.
There are different ways to do a cervical biopsy. All are done by removing tissue to be checked under a microscope. They include:
Endocervical curettage (endocervical scraping). This type of biopsy uses a small tool to scrape cells or tissue from the part of the cervix that is closest to the uterus. It may be done during a colposcopy. This lets the doctor get a sample from a changed or abnormal area that can’t be seen without a magnifying lens.
Cone biopsy (conization). This is one of several types of biopsies used to collect larger pieces of tissue from the cervix. For this type, a knife, laser, or heated wire may be used to remove a bigger cone-shaped piece of the cervix. 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 cramping, bleeding, or other discharge. The area usually heals quickly.
Getting your test results
Your healthcare provider will contact you with your biopsy 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.