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 routine cervical cancer screening.
If your healthcare provider thinks you might have cervical cancer, some exams and tests will be needed to know for 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. A physical exam will be done.
What tests might I need?
You may have 1 or more of the following tests:
Pap and HPV tests
A pelvic exam is done in your healthcare provider's 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 put your feet in supports called stirrups at the end of the table. This position allows the provider to look at and feel your cervix, uterus, vagina, ovaries, fallopian tubes, bladder, and rectum. A plastic or metal tool called a speculum will be put inside your vagina. This lets the provider see the upper portion of your vagina and your cervix. After removing the speculum, the provider puts 1 or 2 gloved fingers into your vagina. The other hand is used to press on your belly (abdomen). This is to feel other organs and check for lumps (masses) or anything unusual.
A recto-vaginal exam might also be done. The healthcare provider puts 1 finger in your rectum and another finger in your vagina. This is to feel the tissue between and around these 2 organs.
Sometimes cervical cancer is found during a pelvic exam. Your provider can’t see precancer changes like dysplasia. But they may see invasive cancer during the 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 concerning cervical cell changes. 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 healthcare provider'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 healthcare provider uses a tool called a speculum to open your vagina and examine the upper part of your vagina and cervix. A small, soft brush, or spatula is used to collect cells from your cervix and vagina. A specialized healthcare provider 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 on the cervix. First a tool called a speculum is put in the vagina to hold it open so the provider can see the cervix. Then the healthcare provider looks closely at your cervix through the binocular-like colposcope. The scope stays outside your body and doesn't touch you. The cervix is washed with a vinegar-like solution that helps show the changes on the cervix. Cells in areas that look different from the normal cervix cells can be removed and sent to the lab for testing. This is called a biopsy.
There are different ways to do a cervical biopsy. All are done by taking out tissue for testing. They include:
Endocervical curettage (endocervical scraping). This type of biopsy uses a small tool to scrape cells or tissue from the cervix. It may be done during a colposcopy. It lets the healthcare provider get cells from an area that can’t be seen.
Cone biopsy (conization). This is 1 of several types of biopsies used to collect larger pieces of tissue from the cervix. To do it, a knife, laser, or heated wire (called a LEEP cone) 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. It 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.