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Cervical Cancer

How is Cervical Cancer Diagnosed?

Thursday, January 8, 2015 - 11:39

Contributing Author: Guy Slowik FRCS

Routine screening for cervical abnormalities can detect early-stage cancer and precancerous conditions that could progress to invasive disease. The process begins with a Pap test, also known as a Pap smear.

For further information about pap smear, go to Pap smear.

This painless office procedure detects about 95% of all cervical cancers and precancerous cervical conditions.

To perform a Pap test, a health professional uses a spatula, brush, or cotton swab to collect cells from the cervix and cervical canal. The cells are then "smeared" on a slide, preserved with a fixative, stained, and sent to a laboratory for microscopic analysis by a cytopathologist (a specialist who studies cells in order to diagnose disease).

If The Pap Test Suggests A Problem

If the Pap test results suggest a problem, the physician will then conduct additional tests. These may include:

ThinPrep Pap Test

The ThinPrep Pap Test, which has been approved by FDA and has been described as more effective than a conventional Pap smear, is a liquid-based test that employs a fluid medium to collect and preserve cervical cells. A woman who receives a ThinPrep Pap Test will not experience any difference in the procedure used to collect the sample of cervical cells.

Speculoscopy

Recently approved by the U.S. Food and Drug Administration (FDA), this procedure involves the use of a magnifier and a special wavelength of light. Speculoscopy allows the physician to see cervical abnormalities that would otherwise be undetectable when performing a Pap test.

Schiller Test And Colposcopy

A physician performing the Schiller test applies a vinegar-like solution to the cervix and then coats it with iodine. Next, the physician performs a colposcopy, which is an examination of the cervix with a magnifying instrument called a colposcope.

Healthy cervical cells look brown, whereas abnormal cells appear white or yellow. The Schiller test and colposcopy are painless office procedures that have no side effects.

If colposcopy reveals abnormal areas on the cervix, the physician will order a biopsy - the removal of tissue for examination under a microscope by a cytopathologist (a specialist who studies cells in order to diagnose disease).

Coloposcopic-Directed Biopsy

The physician uses forceps to remove small pieces of cervical tissue from areas of the cervix where abnormal-looking tissue has been detected. Local anesthetic is sometimes used to numb the cervix, and a woman who undergoes this office procedure may briefly experience pain, mild cramping, or light bleeding.

Endocervical Curretage

This procedure - which generally is performed at the same time as colposcopic biopsy - removes cells from the endocervix (part of the cervix that opens into the uterus).

  • Local anesthetic may be used to numb the cervix before the physician proceeds.
  • Next, a narrow instrument called a curette is inserted into the endocervix.
  • Cells are then removed from this region, which cannot be seen during colposcopy.

A woman who has endocervical curettage may experience menstrual-type cramping or light bleeding for a short time afterward.

Cone Biopsy

This procedure consists of removing a cone-shaped piece of tissue from the cervix. Tissue is removed from the area between the ectocervix (the part of the cervix that connects with the vagina) and the endocervix (the part of the cervix that opens into the uterus). This "transformation zone" is the area where cancerous and precancerous conditions most often develop.

The two methods commonly used to perform cone biopsy are:

  • Loop electrosurgical excision procedure (LEEP) - This procedure is conducted in a physician's office under local anesthesia (the woman will be awake but pain will be blocked). A wire heated by electrical current is used to remove cervical tissue for laboratory analysis. The procedure takes about 10 minutes. Mild cramping may occur during the procedure and afterward. Mild or moderate bleeding may persist for several weeks.
  • Cold knife cone biopsy - The physician uses a surgical scalpel or laser (intense, focused light beam) to remove abnormal cervical tissue. Cold knife cone biopsy is performed in a hospital under general anesthesia. A woman who undergoes the procedure can go home the same day but may experience cramping and bleeding for a few weeks afterward.

Dilation And Curettage (D&C)

If a Pap test doesn't clearly indicate whether abnormalities are caused by problems in the cervix or in the endometrium (lining of the uterus), the physician may conduct a dilation and curettage (D&C). During a "D&C," the physician enlarges the cervix (dilation) and scrapes the inside of the uterus and cervical canal (curettage) to remove tissue for microscopic analysis.

This procedure may be performed in a doctor's office without anesthesia or in an outpatient facility or hospital with epidural, spinal, or general anesthesia. When a D&C is performed without anesthesia, most women report cramps as the cervix is opened. After a D&C, some women experience complications such as bleeding, infection, or - in rare cases - perforation (piercing) of the uterus. D&C's have been performed for many years and, in general, are very safe.

Cervicography

This diagnostic procedure enables a physician to obtain and examine a photographic image of the cervix. Cervicography may clarify abnormal Pap test results in women at above-average risk of developing cervical cancer. It could eventually reduce the need for colposcopy.

If The Cancer Has Spread

If the physician suspects that tumor cells have spread to regions outside of the cervix, he or she may decide that additional tests are needed. In particular, the physician may want to examine the lymph nodes, pelvic area, bladder, and rectum using the following methods:

Cystoscopy

This procedure (also known as cystourethroscopy) lets the physician see the inside of the bladder, bladder neck, and urethra.

During cystoscopy, a cystoscope (thin, telescope-like tube with a tiny attached camera) is inserted into the bladder through the urethra (the passage through which urine passes from the bladder out of the body). This allows the physician to see whether cancer has spread from the cervix to the bladder or urethra.

Conducted under local or general anesthesia, cystoscopy can also be used to remove small tissue samples for microscopic examination.

Proctoscopy

During this procedure, the physician uses a proctoscope (a lighted tube), which is inserted into the rectum to examine the rectum or pelvis. In this way, the doctor can determine whether cancerous cells have spread to these organs from the cervix.

Computed Tomography (Ct Scan)

Computed tomography is an imaging technique in which an x-ray rotates around the body and takes pictures ("scans") at many angles. A computer puts the scans together and creates detailed images of the body's organs in cross-section.

Sometimes a special dye known as contrast medium is injected or drunk to highlight body parts during CT scanning. For example, contrast medium may be used to highlight the intestines and emphasize any spread of cervical cancer within the pelvic cavity and/or to the lymph nodes.

Magnetic Resonance Imaging (MRI)

An MRI is another computer-assisted imaging method. It uses a powerful electromagnet to activate the water molecules within the body and create finely detailed images of tissue. This technique is sometimes used to determine whether cancer has spread from the cervix to the lymph nodes or other nearby organs.

IVP

An intravenous pyelogram (IVP), also called intravenous urography, is a urinary system x-ray conducted to detect abnormalities in the urinary tract. Contrast dye is injected into a vein. Then the physician traces the route of the dye as it is removed from the kidneys and passed through the ureters (tubes that carry urine from the kidneys to the bladder) to the bladder.

This procedure may be used to identify urinary tract abnormalities caused by cancer that may have spread from the cervix.

Baruim Enema

This is a radiographic procedure in which contrast medium is introduced into the bowels through the anus so that the lower intestinal tract is visible on an x-ray.

Chest X-Ray

This imaging procedure shows whether cancer has spread from the cervix to the lungs.

Cervical Cancer