Diagnosing cervical cancer

Thursday 1 October, 2015

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On this page: Colposcopy | Biopsy | Large loop excision of the transformation zone (LLETZ) | Cone biopsy | Further tests | Staging cervical cancer | Prognosis | Which health professionals might I see? | Key points


If your screening test results suggest that you have a higher risk of developing cervical cancer, or you have symptoms of cancer, you will be referred to a specialist for tests to confirm the diagnosis of precancerous changes or cervical cancer.

Some tests allow your doctor to see the tissue in your cervix and surrounding areas more clearly. Other tests tell the doctor about your general health and whether the cancer has spread. You probably won’t need to have all the tests described on this page.

Colposcopy

A colposcopy can help identify where abnormal or changed cells are located in the cervix and what they look like.

While you are lying on your back, the doctor will insert an instrument called a speculum into your vagina to get a clear view of your cervix and vagina. The doctor may coat your cervix and vagina with a fluid to highlight any abnormal areas.

Using an instrument called a colposcope, which has a light and looks like a pair of binoculars sitting on a large stand (see diagram opposite), the doctor can see a magnified picture of your cervix and vagina. The colposcope won’t be put inside you.

You may experience some mild discomfort for 10–15 minutes during the colposcopy. Some colposcopes are fitted with a camera that is connected to a TV screen so you have the option of watching what the doctor is doing.

Colposcopy

Biopsy

A biopsy may be done during the colposcopy. A biopsy is when the doctor removes some tissue from the surface of the cervix and sends it to a laboratory for examination under a microscope.

You will be given a local anaesthetic to numb the cervix so you won’t feel any pain. You will be able to go home once the colposcopy and biopsy are over. The results will be available in about a week.

Side effects of a colposcopy with biopsy

During a biopsy, you may feel uncomfortable for a short time while the tissue sample is taken. After the procedure, it is common to experience cramping that feels similar to menstrual pain. You can ask for medicine to relieve any pain. You may also have some light bleeding or other vaginal discharge for a few hours.

To allow the cervix to heal and to reduce the risk of infection, your doctor will probably advise you not to have sexual intercourse or use tampons for 2–3 days after a biopsy.  

Large loop excision of the transformation zone (LLETZ)

A LLETZ is a procedure to remove cervical tissue for examination and to treat some precancerous changes of the cervix.

A thin wire loop heated by an electrical current is used like a scalpel to remove the abnormal tissue from the transformation zone of the cervix. Sometimes the doctor can remove all visible abnormal cells.

A LLETZ is usually done under a local anaesthetic in the doctor’s office or, sometimes, under a general anaesthetic in hospital. It takes about 10 minutes. Sometimes it is done at the same time as a colposcopy and biopsy (see above).

Once the tissue sample has been taken, it will be sent to a laboratory for examination under a microscope. The results will be available in about a week.

Side effects of a LLETZ

After a LLETZ, you may have some vaginal bleeding and cramping. This will usually ease in a few weeks. To give your cervix time to heal and to prevent infection, you should not have sexual intercourse or use tampons for 4–6 weeks after the procedure.

A LLETZ does not usually affect your ability to become pregnant, but it may slightly increase your risk of having the baby prematurely. Talk to your doctor before the procedure if you are concerned.

Laser surgery

A laser can be used to remove tissue from the cervix and to treat some precancerous changes in the cervix. Local anaesthetic is injected into the cervix and a laser beam is used to remove some tissue. Laser surgery is just as effective as LLETZ and may be a better option if the precancerous cells extend into the wall of the vagina or if the lesion on the cervix is very large. The side effects of laser surgery are similar to those of LLETZ.  

Cone biopsy

A cone biopsy is done to determine how deeply cancer cells have spread into tissue beneath the surface of the cervix. It is also used to treat very small, early-stage tumours. It is called cone biopsy because a cone-shaped piece of tissue is removed from the cervix.

The cone biopsy is usually done under a general anaesthetic and involves a day or overnight stay in hospital. Results are usually available in a week. 

Having a cone biopsy
Side effects of a cone biopsy

You may have some light bleeding or cramping for a few days after the cone biopsy. Avoid doing anything strenuous for a few weeks, as this could cause the bleeding to become heavier or start again.

If the bleeding lasts longer than two weeks, becomes heavy or has a bad odour, see your doctor. To allow your cervix to heal and to prevent infection, you should not have sexual intercourse or use tampons for 4–6 weeks after the procedure.

A cone biopsy may weaken the cervix. If you would like to become pregnant in the future, talk to your doctor before the procedure. It is usually still possible to become pregnant, but you may be at a higher risk of having a miscarriage or having the baby prematurely. Some women who become pregnant after a cone biopsy have stitches inserted into the cervix to strengthen it. These stitches are usually removed before the baby is born.

Further tests

If any of the tests described above show that you have cervical cancer, you may need to have further tests to help the doctor work out whether the cancer has spread to other parts of your body. This is called staging. You may have one or more of the tests described below.

Blood tests and chest x-ray

You may have a blood test to check your general health and how well your kidneys and liver are working. You may also have an x-ray of your chest so the doctor can check your lungs for signs of cancer.

CT scan

A CT (computerised tomography) scan is a type of x-ray that takes detailed, three-dimensional pictures of the inside of the body.

The scan can show whether the cancer has spread to lymph nodes in the abdomen or pelvis or to other organs in the body. Before the scan, you may be given a drink or an injection of a dye. This may make you feel hot all over for a few minutes. You may also be asked to insert a tampon into your vagina. The dye and the tampon make the pictures clearer and easier to read.

The CT scanner is large and round like a doughnut. You will lie flat on a table that moves in and out of the scanner. The scan is painless and takes 5–10 minutes.

The dye used in a CT scan usually contains iodine. If you know you’re allergic to iodine or dyes, let the person performing the scan know in advance. You should also tell the doctor if you’re diabetic, have kidney disease or are pregnant.  

MRI scan 

An MRI (magnetic resonance imaging) scan uses a powerful magnet and radio waves to create detailed pictures of areas inside the body. Sometimes, dye will be injected into a vein before the scan to help make the pictures clearer.

During the scan, you will lie on a table that slides into a metal cylinder that is open at both ends. The machine makes a series of bangs and clicks and can be quite noisy. You will usually be given headphones to help block out the noise.

The scan is painless, but some people feel anxious lying in the narrow cylinder. Tell your doctor or nurse beforehand if you are prone to anxiety or claustrophobia. They can suggest breathing exercises or give you medicine to help you relax.

You will be asked to complete a checklist before the scan that asks whether you have any metal implants in your body, such as a pacemaker. If you do have any metal in your body, you may not be able to have an MRI scan.

The scan takes less than an hour, and most people are able to go home as soon as it is over. 

PET scan

Before a PET (positron emission tomography) scan, you will be injected with a small amount of a glucose (sugar) solution containing some radioactive material. You will be asked to rest for 30–60 minutes while the solution spreads throughout your body.

Your body will then be scanned for high levels of radioactive glucose. Cancer cells show up brighter on the scan because they absorb more of the glucose solution than normal cells do.

It may take a few hours to prepare for a PET scan, but the scan itself usually takes about one hour. The radioactive material in the glucose solution is not harmful and will leave your body within a few hours. 

Examination under anaesthetic 

The doctor may want to examine your cervix, vagina, uterus, bladder and rectum to check whether the cancer has spread. For this procedure, you will need to have a general anaesthetic in hospital.

If the doctor sees any abnormal areas of tissue during the procedure, they will take a biopsy and send the sample to a laboratory for examination.

Pelvic examination

The doctor will insert a speculum into your vagina to get a clear view of your cervix and vagina.

Uterus

The cervix will be dilated (stretched) and some of the cells in the lining of the uterus (endometrium) will be removed and sent to a laboratory for examination under a microscope. This is called a dilation and curettage (D&C). A D&C is also sometimes used to treat precancerous changes in the cervix (see cervical cell changes).

Bladder

A thin tube with a lens and a light called a cystoscope will be inserted into your urethra (the tube that carries urine from the bladder to the outside of the body) to examine your bladder.

Rectum

The doctor will use a gloved finger to check for any abnormal growths inside your rectum. To examine your rectum more closely, the doctor may insert an instrument called a sigmoidoscope, which is a flexible tube with a camera attached.

 

You will most likely be able to go home from hospital on the same day as the examination under anaesthetic. You may have some light bleeding and cramping for a few days afterwards. Your doctor will talk to you about side effects you may experience. 

Staging cervical cancer

The tests described in this chapter show whether you have cervical cancer, the size of the tumour and whether it has spread (the stage). Knowing the stage helps doctors plan the best treatment for you. One of the following stages will be used to describe the cancer:

Cervical cancer stages
Stage 1 The cancer is found only in the tissue of the cervix.
Stage 2 The cancer has spread outside the cervix to the upper part of the vagina or other tissue next to the cervix.
Stage 3 The cancer has spread to the tissue on the side of the pelvis (pelvic sidewall) and/or the lower part of the vagina.
Stage 4 The cancer has spread to the bladder or rectum, or beyond the pelvis to the lungs, liver or bones.

Prognosis

Prognosis means the expected outcome of a disease. You will need to discuss your prognosis and treatment options with your doctor, but it is not possible for any doctor to predict the exact course of the disease.

In general, the sooner cervical cancer is diagnosed, the better the prognosis. Most women with early-stage cervical cancer will go into remission, which is when signs and symptoms of the cancer reduce or disappear.

To work out your prognosis, your doctor will consider:

  • your test results
  • the type of cervical cancer you have
  • the rate and depth of tumour growth
  • how well you respond to treatment
  • other factors such as your age, fitness and medical history. 

Which health professionals might I see?

Your GP will arrange the first tests to assess your symptoms or investigate the results of an abnormal screening test. If these initial tests do not rule out cancer, you will be referred to a gynaecologist or gynaecological oncologist for more tests and treatment.

You will be cared for by a range of health professionals who will form a multidisciplinary team (MDT). The table on the following page describes the role of the people who may be in your MDT.

Health professional Role
gynaecologist specialises in treating diseases of the female reproductive system
gynaecological oncologist treats women with cancers of the reproductive system (e.g. cervical, ovarian, uterine, vulvar and vaginal cancers)
radiation oncologist prescribes and coordinates the course of radiotherapy
medical oncologist prescribes and coordinates the course of chemotherapy
radiologist reads and interprets diagnostic scans (e.g. CT, MRI and PET scans)
cancer nurse coordinator, cancer care coordinator supports patients and families throughout treatment and liaises with other members of the treatment team
nurses care for you during and after surgery; help administer drugs; and provide care, information and support throughout treatment
dietitian recommends an eating plan to follow while you are having treatment and during recovery
social worker, psychologist, physiotherapist and occupational therapist link you to support services; help with emotional problems associated with cancer and treatment
physiotherapist, occupational therapist help with any physical or practical problems associated with cancer and treatment

Key points

  • Changes in the cervix that may lead to cancer are detected by a screening test.
  • An examination of cervical tissue will show whether cells in the cervix are cancerous.
  • During a colposcopy, the doctor examines the cervix and vagina using an instrument called a colposcope.
  • A biopsy is when a small sample of tissue is removed from the cervix for examination under a microscope.
  • A large loop excision of the transformation zone (LLETZ) or laser surgery are done to remove a sample of tissue from the cervix or treat precancerous changes.
  • During a cone biopsy, a cone-shaped piece of tissue is removed from the cervix. This is done in hospital under general anaesthetic. A cone biopsy may be used to treat early-stage cervical tumours.
  • Further examinations or scans may be performed to check whether the cancer has spread to other parts of the body.
  • Staging describes how far the cancer has spread in the body. Knowing the stage of the cancer allows the doctor to recommend the best treatment for you.
  • Prognosis is the expected outcome of a disease. Generally, the sooner cervical cancer is diagnosed, the better the prognosis.
  • You will be treated by a gynaecologist or gynaecological oncologist and other health professionals, who will work together in a multidisciplinary team.

Reviewed by: Dr Archana Rao, Gynaecological Oncologist, Royal Hospital for Women, NSW; Danielle Carpenter, Gynaecological Cancer Nurse Consultant, Gynaecology Unit, The Royal Women’s Hospital, VIC; Carmen Heathcote, 13 11 20 Consultant, Cancer Council Queensland, QLD; A/Prof Michael Jackson, Director, Radiation Oncology, Prince of Wales Hospital, NSW; Haley McNamara, Social Worker, Cancer Care Services, Metro North Hospital and Health Service, QLD; Isabelle Rousseau, Consumer.
Updated: 01 Oct, 2015