Diagnosis of Cervical cancer

Executive Summary

Different tests are available to diagnose cervical cancer, which depends on signs and symptoms, age and health status, types of cancer suspected, and earlier medical tests. Biopsy and imaging tests are the common diagnostic approach for cervical cancer. Some other diagnostic tests for cervical cancer include Bimanual pelvic examination and sterile speculum examination, Pap test, HPV typing test, Colposcopy, Biopsy, Endocervical Curettage (ECC), Loop Electrosurgical Excision Procedure (LEEP), Conization (a cone biopsy), Pelvic examination under anesthesia, X-ray, Computed tomography (CT or CAT) scan, Magnetic Resonance Imaging (MRI), Molecular testing of the tumor, Cystoscopy, and Sigmoidoscopy.

Diagnostic Approach for Cervical Cancer

Many tests are performed for the diagnosis of cervical cancer. Also, tests are done to learn if the cancer has spread to parts other than where it started. The spread of the tumor to other regions is called metastasis.

Biopsy is a sure way to know if you have cancer in a particular part or organ of the body for most types of cancer.

Imaging tests can help doctors determine if the tumor or cancer has metastasized to the brain from elsewhere in the body ^​1​.

The different tests can be used for a person depending upon the following factors – 

• Your signs and symptoms
• The age and general health status
• The type of cancer suspected
• The result of earlier medical tests

The below-mentioned test may be used for the diagnosis of cervical cancer –

Bimanual pelvic examination and sterile speculum examination:

In this examination, the doctor will check for any unusual changes in the patient’s ovaries, uterus, cervix, vagina and nearby organs ^​2​. To start, the doctor will see for any changes to the vulva outside the body and then, using an instrument known as a speculum that keeps the vaginal walls open, the doctor will see inside the vagina to picture the cervix. A Pap test is usually performed at the same time. Some of the surrounding organs are not visible during this exam, so the doctor inserts two fingers inside the vagina. At the same time, the other hand softly presses on the lower abdomen to feel the ovaries and uterus. This exam takes about a few minutes and is done in an examination room at the doctor’s office.

Pap test

During a Pap test, the doctor scrapes the outside and inside of the cervix, removing samples of cells for testing. Improved Pap test methods have made it less complicated for doctors to locate cancerous cells ^​3​. Traditional Pap tests can become hard to read because cells can be dried out, clump together on the slide or covered with mucus or blood.

The liquid-based cytology test, mainly referred to as SurePath or ThinPrep, transfers a thin layer of cells on a slide after eliminating mucous or blood from the sample. This sample is preserved so other tests can be done simultaneously, like the HPV test.

Computer screening, usually called AutoPap or FocalPoint, uses a computer to scan the sample for abnormal cells.

HPV typing test

An HPV test resembles a Pap test. The test is done on the cells from the cervix. The doctor may test for HPV simultaneously as a Pap test or after Pap test results show abnormal changes to the cervix. Certain types or strains of HPV, known as high-risk HPV, such as HPV18 and HPV16, are seen primarily on women with cervical cancer and can help confirm a diagnosis of Cervical cancer. If the HPV test is “positive,” this means there is a presence of high-risk HPV. Many women having HPV may not have cervical cancer, so HPV testing alone cannot diagnose cervical cancer.

Colposcopy

The doctor may perform a colposcopy to check the cervix for abnormal parts ^​4​. Colposcopy can also help guide a biopsy of the cervix. During a colposcopy, a unique instrument known as a colposcope is used. The colposcope magnifies the cells of the vagina and cervix like a microscope. It provides a lighted, magnified view of the vagina and the cervix tissues. It can be performed in the doctor’s office and has no side effects. It can also be performed on pregnant women.

Biopsy

A biopsy removes a small part of tissue to examine under a microscope. A biopsy can also be done as surgery to remove the entire tumor. The type of biopsy performed depends upon the position of the tumor. 

There are various types of biopsies. Most of which is done in the doctor’s office, sometimes using a local anesthetic to numb the area. There can be some bleeding and other discharge after a biopsy. There may also be discomfort like menstrual cramps. One standard biopsy method uses an instrument to pinch off small pieces of cervical tissue. Other types of biopsies include:

Endocervical Curettage (ECC)

If the doctor wants to view an area inside the opening of the cervix that cannot be seen during a colposcopy, they will use ECC ^​5​. The doctor uses a small, spoon-shaped instrument called a curette to scrape a small amount of tissue inside the cervical opening during this procedure.

Loop Electrosurgical Excision Procedure (LEEP)

LEEP uses an electrical current that passes through a thin wire hook. This hook helps in the removal of tissue for laboratory examination. A LEEP can also be used to remove a precancer or early-stage cervical cancer ^​6​.

Conization (a cone biopsy)

Conization takes out a cone-shaped part of the tissue from the cervix. Conization can be done to remove a precancer/early-stage cervical cancer ^​7​. It is done under a general or local anaesthetic and may be done in the doctor’s office or the hospital.

If the biopsy shows that cervical cancer is present, the doctor will recommend you to a gynecologic oncologist specializing in treating this type of cancer. The specialist may recommend additional tests to see if cervical cancer has spread beyond the cervix.

Pelvic examination under anesthesia

For treatment planning, the specialist may re-examine the pelvic area while the patient is under anesthesia to see if cervical cancer has spread to organs near the cervix, including the vagina, uterus, bladder, or rectum ^​8​.

X-ray

An x-ray is a way to create a picture of the structures inside the body using a small quantity of radiation that is used for diagnosis of cervical cancer. An intravenous urography is a kind of x-ray used to view the kidneys and bladder.

Computed tomography (CT or CAT) scan

A CT scan clicks pictures of the body from inside using x-rays taken from different angles. A computer combines photos into a detailed, 3-dimensional image that shows abnormalities or tumours. A CT scan helps measure the tumor’s size. Sometimes, a special dye known as a contrast medium is given before the scan to provide better detail on the image. This dye can be delivered into a patient’s vein or given as a pill or liquid to swallow.

Magnetic Resonance Imaging (MRI)

An MRI uses magnetic fields, not x-rays, to produce detailed body images. A specific dye known as contrast medium is given before the scan to create a better picture. This dye can be delivered into a patient’s vein or given as a pill or liquid to swallow.

Positron Emission Tomography or PET-CT scan

PET scan creates images of organs and tissues present inside the body. A small quantity of a radioactive substance is injected into the patient’s body which is taken up by cells using the most energy. The cervical cancer cells which use energy actively take up the radioactive substance, and the scanner then spots this substance to produce images of the inside of the body. In bone cancer, this scan provides a more comprehensive view to determine the presence of abnormal activity, even before a tumour may have developed.       

Molecular testing of the tumor 

The doctor may recommend running laboratory tests to identify proteins, specific genes, and other factors unique to the tumor. 

If there are symptoms or signs of rectal or bladder problems, these procedures may be suggested and performed at the same time as a pelvic examination:

Cystoscopy

A cystoscopy is a process that allows the doctor to see inside the bladder and urethra with a thin, lighted tube known as a cystoscope. The patient may be sedated while the tube is inserted into the urethra. A cystoscopy is used to check whether cervical cancer has spread to the bladder ^​9​.

Sigmoidoscopy

A sigmoidoscopy is a process that allows the doctor to see the colon and rectum with a thin, flexible, lighted tube known as a sigmoidoscope ^​10​. The patient may be sedated while the tube is inserted into the rectum. A sigmoidoscopy is used to know if cervical cancer has spread to the rectum.

When diagnostic tests are completed, the doctor will review the results with you.

References