On this page:
Large loop excision of the transformation zone (LLETZ) |
Cone biopsy |
Further tests |
Staging cervical cancer |
Which health professionals might I see? |
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.
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.
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
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.
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.
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.
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.
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.
A CT (computerised tomography) scan is a type of x-ray that takes
detailed, three-dimensional pictures of the inside of the body.
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.
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.
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.
The doctor will insert a speculum into
your vagina to get a clear view of your cervix and vagina.
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).
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.
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
||The cancer is found only in the tissue of the cervix.
||The cancer has spread outside the cervix
to the upper part of the vagina or other
tissue next to the cervix.
||The cancer has spread to the tissue on
the side of the pelvis (pelvic sidewall)
and/or the lower part of the vagina.
||The cancer has spread to the bladder or
rectum, or beyond the pelvis to the lungs,
liver or bones.
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.
||specialises in treating diseases of the female
||treats women with cancers of the reproductive
system (e.g. cervical, ovarian, uterine, vulvar
and vaginal cancers)
||prescribes and coordinates the course
||prescribes and coordinates the course
||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
||care for you during and after surgery;
help administer drugs; and provide care,
information and support throughout treatment
||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
- 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 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
- 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.