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Tests and diagnosis
By Mayo Clinic staff
Screening
When cervical cancer is detected in its earliest stages, treatment is more likely to be successful. Regular screening for cervical cancer and precancerous changes in the cervix is recommended for all women. Most guidelines suggest beginning screening at age 21. Screening for cervical cancer includes:
- Pap test. During a Pap test, your doctor brushes cells from your cervix — the narrow neck of the uterus — and sends the sample to a lab to be examined for abnormalities. A Pap test can detect abnormal cells in the cervix, including cancer cells and cells that show changes (dysplasia) that increase the risk of cervical cancer.
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HPV DNA test. Your doctor may also use a lab test called the HPV DNA test to determine whether you are infected with any of the types of HPV that are most likely to lead to cervical cancer. Like the Pap test, the HPV DNA test involves collecting cells from the cervix for lab testing.
The HPV DNA test isn't a substitute for regular Pap screening, and it's not used to screen women younger than 30 with normal Pap results. However, an HPV test may be combined with a Pap test to extend the recommended screening period from three to five years for women between the ages of 30 and 65. Most HPV infections in women of this age group clear up on their own and aren't associated with cervical cancer.
Diagnosis
If you experience signs and symptoms of cervical cancer or if a Pap test has revealed cancerous cells, you may undergo further tests to diagnose your cancer. To make a diagnosis, your doctor may:
- Examine your cervix. During an exam called colposcopy, your doctor uses a special microscope (colposcope) to examine your cervix for abnormal cells. If your doctor identifies unusual areas, he or she may take a small sample of cells for analysis (biopsy).
- Take a sample of cervical cells. During a biopsy procedure your doctor removes a sample of unusual cells from your cervix using special biopsy tools.
- Remove a cone-shaped area of cervical cells. A cone biopsy (conization) — so called because it involves taking a cone-shaped sample of the cervix — allows your doctor to obtain deeper layers of cervical cells for laboratory testing. Your doctor may use a scalpel, laser or electrified wire loop to cut away the tissue.
Staging
If your doctor determines that you have cervical cancer, you'll undergo further tests to determine whether your cancer has spread and to what extent — a process called staging. Your cancer's stage is a key factor in deciding on your treatment. Staging exams include:
- Imaging tests. Tests such as X-rays, computerized tomography (CT) scans and magnetic resonance imaging (MRI) help your doctor determine whether your cancer has spread beyond your cervix.
- Visual examination of your bladder and rectum. Your doctor may use special scopes to see inside your bladder (cystoscopy) and rectum (proctoscopy).
Your doctor then assigns your cancer a stage — typically a Roman numeral. Stages of cervical cancer include:
- Stage I. Cancer is confined to the cervix.
- Stage II. Cancer at this stage includes the cervix and uterus, but hasn't spread to the pelvic wall or the lower portion of the vagina.
- Stage III. Cancer at this stage has moved beyond the cervix and uterus to the pelvic wall or the lower portion of the vagina.
- Stage IV. At this stage, cancer has spread to nearby organs, such as the bladder or rectum, or it has spread to other areas of the body, such as the lungs, liver or bones.
- Jhingran A, et al. Cancers of the cervix, vulva and vagina. In: Abeloff MD, et al. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2008:1745.
- Cervical cancer. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/PDF/cervical.pdf. Accessed April 12, 2011.
- What you need to know about cervical cancer. National Cancer Institute. http://www.cancer.gov/cancertopics/wyntk/cervix. Accessed April 12, 2011.
- Noller KL. Intraepithelial neoplasia of the lower genital tract (cervix, vulva): Etiology, screening, diagnostic techniques, management. In: Katz VL, et al. Comprehensive Gynecology. 5th ed. Philadelphia, Pa.: Mosby Elsevier; 2007. http://www.mdconsult.com/das/book/body/208746819-4/0/1524/0.html. Accessed April 14, 2011.
- Cervical cancer screening. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/PDF/cervical_screening.pdf. Accessed April 12, 2011.
- HPV (human papillomavirus) vaccine: Gardasil. What you need to know. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-hpv-gardasil.pdf. Accessed April 14, 2011.
- HPV (human papillomavirus) vaccine: Cervarix. What you need to know. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-hpv-cervarix.pdf. Accessed April 14, 2011.
- Your first gynecologic visit. American Congress of Obstetricians and Gynecologists. http://www.acog.org/publications/patient_education/bp150.cfm. Accessed April 14, 2011.
- Moyer VA, et al. Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine. http://www.annals.org/content/early/2012/03/14/0003-4819-156-12-201206190-00424.full#sec-9. Accessed March 15, 2012.
- New screening guidelines for cervical cancer. American Cancer Society. http://www.cancer.org/Cancer/news/News/new-screening-guidelines-for-cervical-cancer. Accessed March 15, 2012.
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