Diagnosis & Tests

for Cervical Cancer

Doctors who care for women routinely perform pelvic examinations and a Papanicolaou (Pap) smear to screen for cervical cancer in the cells on the surface of the cervix. During a Pap smear, a sample of cells from the cervix is taken with a small wooden spatula or brush and examined under the microscope. Women may first become aware that they have cervical cancer when a suspicious area is identified during a pelvic examination or an abnormal Pap smear. If a suspicious or a precancerous lesion is found, a biopsy and additional tests will be recommended to determine whether a precancerous lesion or invasive cancer exists.  A biopsy is the removal of a sample of tissue from the cervix in order to evaluate cervical cells under a microscope.

Cells taken from the surface of the cervix can appear abnormal, but may not be cancer. These abnormal cells, however, may be the first step in a series of changes that lead to cancer. Doctors refer to the abnormal cells as “precancerous” and have used different terms to refer to them, such as squamous intraepithelial lesions, dysplasia, cervical intraepithelial neoplasia or carcinoma in situ. Precancerous disease involves only the surface of the cervix. When the abnormal cells begin to spread deeper into the cervix, they are referred to as invasive cancer of the cervix.

Physicians may use a colposcope (lighted microscope) to better visualize the cervix or to perform a biopsy. If the doctor cannot determine whether the abnormal cells are only on the surface of the cervix, an endocervical curettage or conization may be recommended.

  • Endocervical Curettage: This procedure may be performed at the same time as the punch biopsy, especially if there is concern that there may be abnormal tissue past the opening of the cervix that cannot be seen with the colposcope. During an endocervical curettage, a small spoon-shaped instrument called a curette is used to scrape cells away from inside the endocervical canal. These cells are then sent to the lab for examination under a microscope.
  • Conization: If the information obtained from colposcopy, biopsy and/or curettage is inconclusive, a physician might perform a conization. During a conization, or cone biopsy, the physician removes a cone-shaped sample of tissue from the cervical canal. The sample is then sent to the lab for examination. Conization can also serve as the primary treatment of precancerous cervical cancer, as a large sample is removed and can sometimes remove any cancerous tissue in the process. This is a fairly intrusive procedure and can involve significant complications.
  • Loop Electrosurgical Excision Procedure (LEEP): Loop electrosurgical excision procedure (LEEP), also called large loop excision of the transformation zone (LLETZ), is simpler and less invasive than conization. During LEEP, a physician applies a local anesthetic to the cervix and then inserts a wire loop into the vagina. A high frequency electrical current is run through the wire to remove abnormal tissue from both the cervix and the endocervical canal. Like conization, LEEP can be used not only as a diagnostic tool, but also as treatment, as large and deep sections of abnormal tissue can be removed.
  • Endometrial biopsy: An endometrial biopsy refers to the removal of a tissue sample from the lining of the uterus (the endometrium). Endometrial biopsy may be performed in some women whose Pap test indicates atypical glandular cells.

Infrequently, it may still remain unclear whether the abnormal cells are confined to the cervix or arise from inside the uterus. In this situation, a dilatation and curettage (D and C) may be recommended. During a D and C, the cervical opening is stretched (dilated) and a curette is inserted to remove cells from the lining of the uterus and cervical canal.

HPV DNA Test The HPV DNA test involves testing cells collected from the cervix for infection with any of the types of HPV that are most likely to lead to cervical cancer.1,2

Staging

When diagnosed with cervical cancer further tests are necessary to determine the extent of spread (stage) of the cancer. Cancer’s stage is a key factor in determining the best treatment.

Imaging tests. Tests such as X-rays, CT scans, magnetic resonance imaging (MRI) and positron emission tomography (PET) are used to help determine the stage and whether the cancer has spread beyond the cervix.

Precision Medicine & Personalized Cervical Cancer Care

The purpose of precision cancer medicine is not to categorize or classify cancers solely by site of origin, but to define the genomic alterations in the cancers DNA that are driving that specific cancer.  Cancer used to be diagnosed solely by a visual microscopic examination of tumor tissue and all patients received the same chemotherapy.  Precision cancer medicine utilizes molecular diagnostic & genomic testing, including DNA sequencing, to identify cancer-driving abnormalities in a cancer’s genome. Once a genetic abnormality is identified, a specific targeted therapy can be designed to attack a specific mutation or other cancer-related change in the DNA programming of the cancer cells. Precision cancer medicine uses targeted drugs and immunotherapies engineered to directly attack the cancer cells with specific abnormalities, leaving normal cells largely unharmed. Precision medicines are being developed for the treatment of cervical cancer and patients should ask their doctor about whether testing is appropriate.

Learn more here: http://oncoprecision.org/

Stages of Cervical Cancer

Stage 0: Precancerous lesion involves only the cells on the surface of the cervix.

Stage I: Cancer is confined to the cervix, and may be evident only under microscopic evaluation (stage IA) or apparent by visible or physical examination (stage IB).

Stage II: Cancer has spread beyond the cervix to involve the tissues surrounding the cervix (parametria) or the upper portion of the vagina.

Stage III: Cancer spreads beyond the cervix to the lower vagina or to the sides of the pelvis, or causes a blockage of drainage from the kidney, a condition called hydronephrosis.

Stage IV: Cancer invades structures adjacent to the cervix such as the bladder or rectum or has spread to other parts of the body such as the liver or lungs.

Recurrent/Relapsed: Cervical cancer is still detected or has returned (recurred/relapsed) following an initial treatment with surgery, radiation therapy, and/or chemotherapy.

Next: Screening/Prevention of Cervical Cancer

References

1 American Cancer Society. Cancer Facts & Figures 2012.

2 National Cancer Institute Fact Sheet. Human Papillomaviruses and Cancer: Questions and Answers.