By Dr Ananya Mandal, MD
Cervical cancer is diagnosed with the help of a gynaecologist, a pathologist and an imaging radiologist. Cancer may be suspected if there is abnormal bleeding after or during sexual intercourse or if there is bleeding after menopause.
Cervical cancer screening
Regular screening tests include Pap smears and cervical cell cytology that involve taking a sample of cells from the inner lining of the cell and examining it under the microscope. These are performed three yearly n women between 25 and 49 and 5 yearly in women over 50 until 64.
Initial steps of diagnosis
Initial steps of diagnosis involve detailed history of menopause (if attained), sexual intercourse history, history of vaginal bleeding, pain, vaginal discharge, sexually transmitted infections etc. The gynaecologist then examines the patient. Following physical examination further tests are advised.
If the initial results of screening test is positive or if there are symptoms suggestive of cervical cancer, the gynaecologist carries out a colposcopy. A colposcopy is an internal vaginal examination to look for any abnormalities in the cervix.
A thin flexible tube with a light source at the end (colposcope) is used to examine the cervix. The appearance of the cervix and presence of lesions is noted.
Along with examination, a small tissue sample or biopsy is taken from the cervix during the procedure. This is relatively painless procedure and the patient may be sedated or locally anesthetized before performing a colposcopy.
There are several different methods of biopsy. This may be carried out in a hospital and is a minor operation. This is performed under a local anesthetic.
For this biopsy, a small, cone-shaped section of the cervix is removed so that it can be examined under a microscope for cancerous cells. There may be slight pain and bleeding after this procedure.
Pelvic examination under general anaesthesia
The patient is made unconscious with general anaesthesia and the abdomen is opened to examine the uterus, vagina, rectum and bladder for spread of the cancer. This can be done by making a large abdominal incision (laparotomy) or may be done using small incisions called laparoscopy.
Blood tests are prescribed to check for liver, kidney and bone marrow function and affliction by the cancer.
Computerized tomography (CT) scans
This is a series of X rays that give a detailed picture of the organs within the body. It also helps in detection of spread of the cancer.
Magnetic resonance imaging (MRI) scan
This imaging test uses strong magnetic fields and radio waves to produce pictures of the structures within the body.
A chest X ray may be suggested to detect spread of the cancer to the lungs.
Positive emission tomography (PET) scan
This is similar to MRI and is performed to show how the cancer has spread to other organs like bones.
Once the tests have been conducted the cancer is staged. Staging is an assessment of how far the cancer has progressed. If it is a lower stage then the cancer is likely to be localized and if it is a higher stage, it has spread to other major organs like lungs, liver, brain and bones. The lower the stage, the more likely a complete cure will be possible.
Stage 0 – this is a pre-cancer stage and there are no cancerous cells in the cervix. This stage however has cells that are abnormal and can progress to full blown cancer.
Stage 1 - cancer is still localized inside the cervix.
Stage 2 - cancer has spread outside the cervix into the upper section of the vagina or in surrounding tissue.
Stage 3 –cancer has spread into the lower section of the vagina and/or into the tissue of the pelvis.
Stage 4 - cancer has spread into the rectum, intestines, bladder and lungs.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)