If you have symptoms or your cervical screening test results suggest that you have a higher risk of developing cervical cancer, you will usually have more tests. Some tests allow your doctor to see the tissue in your cervix and surrounding areas more clearly, while others tell the doctor about your general health and whether the cancer has spread.
Colposcopy and biopsy
A colposcopy is a way of looking closely at the cervix and vagina to see if there are any abnormal or changed cells. It takes about 10–15 minutes and involves a microscope with a light being placed near your vulva.
If the colposcopist sees any suspicious-looking areas, they will usually take a tissue sample (biopsy) from the surface of the cervix to see if cells are cancerous. You will be able to go home once the colposcopy and biopsy are done. The results are usually available in about a week.
After the procedure, it is common to have cramping that feels similar to menstrual pain. You may also have some light bleeding or other vaginal discharge for up to a week. You will probably be advised not to have sexual intercourse or use tampons for up to a week after the procedure.
Treating precancerous abnormalities
If any of the tests show precancerous cell changes, you may have one of the following procedures to remove the area of abnormal cells and prevent you developing cervical cancer.
Large loop excision of the transformation zone (LLETZ)
Also called loop electrosurgical excision procedure (LEEP), this is the most common way of treating precancerous changes of the cervix. The abnormal tissue is removed using a thin wire loop that is heated electrically. The aim is to remove all the abnormal cells from the surface of the cervix.
A LLETZ or LEEP is done under local anaesthetic in your doctor’s office or under local or general anaesthetic in hospital. It takes about 10–20 minutes and results are usually available within a week.
You may have some vaginal bleeding and cramping after the procedure. These side effects will usually ease in a few days, but you may notice some spotting for several weeks. If the bleeding lasts longer than 3–4 weeks, becomes heavy or has an unpleasant smell, see your doctor.
You should not have sexual intercourse or use tampons for 4–6 weeks after the procedure. You will also need to avoid swimming pools and spas. After a LLETZ or LEEP you can still become pregnant, but you may have a slightly higher risk of having the baby prematurely. Talk to your doctor before the procedure if you are concerned.
This procedure is similar to a LLETZ. It is used when abnormal cells are found in the cervical canal, for women who need a larger area removed or when early-stage cancer is suspected. In some cases, a cone biopsy is also used to treat very early-stage cancers, particularly for young women who would like to have children in the future.
A cone biopsy is usually done as day surgery in hospital under general anaesthetic. A surgical knife (scalpel) is used to remove a cone-shaped piece of tissue from the cervix, which is examined to make sure all the abnormal cells have been removed. Results are usually available within a week.
After a cone biopsy, you may have some light bleeding or cramping for a few days. Avoid doing any heavy lifting for a few weeks. If the bleeding lasts longer than 3–4 weeks, becomes heavy or has an unpleasant smell, see your doctor.
You may notice a dark brown discharge for a few weeks, but this will pass. You should not have sexual intercourse or use tampons for 4–6 weeks.
A cone biopsy may weaken the cervix. You can still become pregnant after a cone biopsy, but you may be at a higher risk of having a miscarriage or having the baby prematurely. If you would like to become pregnant in the future, talk to your doctor before the procedure.
This procedure uses a laser beam (a strong, hot beam of light) to vaporise or remove the abnormal cells. The laser beam is pointed at the cervix through the vagina. Laser surgery is done under either local or general anaesthetic. It takes about 10–15 minutes, and you can go home as soon as the treatment is over and you have recovered from the anaesthetic.
Laser surgery works just as well as LLETZ to remove precancerous cells and may be a better option if the precancerous cells extend from the cervix into the vagina or if the lesion on the cervix is very large.
Side effects of laser surgery are similar to those of LLETZ or LEEP. You are usually able to return to your usual activities after 2–3 days, but you should not have sexual intercourse or use tampons for 4–6 weeks. You will also need to avoid swimming pools and spas.
If any of the tests above show that you have cervical cancer, you may need further tests to find out whether the cancer has spread to other parts of your body. Listen to the Tests and Cancer episode of The Thing About Cancer podcast for further information.
Before having scans, tell the doctor if you have any allergies or have had a reaction to contrast during previous scans. You should also let them know if you have diabetes or kidney disease, or are pregnant or breastfeeding.
You may have a blood test to check your general health, and how well your kidneys and liver are working.
You may have one or more of the following imaging scans to find out if the cancer has spread to lymph nodes in the pelvis or abdomen, or to other organs in the body:
- CT scan – uses x-rays to take pictures of the inside of your body and then compiles them into a detailed, three-dimensional picture. It is painless and takes 5–10 minutes.
- MRI scan – uses a powerful magnet and radio waves to create detailed cross-sectional pictures of the inside of your body. It is painless and takes between 30 and 90 minutes. Let your medical team know if you have a pacemaker or any other metal implant, as some may affect how an MRI works.
- PET–CT scan – a specialised imaging test that provides more detailed information about the cancer than a CT scan on its own. Not all women need to have a PET–CT scan. You will be injected with a glucose (sugar) solution containing a small amount of radioactive material to help cancer cells show up brighter. Let your doctor know if you are claustrophobic, as you need to be in a confined space for the scan. It may take a few hours to prepare, but the scan itself usually takes about 30 minutes.
Examination under anaesthetic
Another way to check whether the cancer has spread is for the doctor to examine your cervix, vagina, uterus, bladder and rectum. This is done in hospital under general anaesthetic. If the doctor sees any abnormal areas of tissue during the procedure, they will take a biopsy.
The area examined will depend on where the cancer may have spread to and may include:
- Pelvic examination – the doctor will put a speculum into your vagina and spread the walls of the vagina apart so they can check the cervix and vagina for cancer.
- Uterus – the cervix will be dilated (gently opened) 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).
- Bladder – a tube with a camera and light on the end (a cystoscope) will be inserted into your urethra (a tube that drains urine from the bladder to the outside of the body). This lets the doctor examine your bladder.
- Rectum – the doctor will use a gloved finger to feel 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 tube with an attached camera.
You will most likely be able to go home from hospital on the same day after one of these examinations. You may have some light bleeding and cramping for a few days afterwards. Your doctor will talk to you about the side effects you may have.
Staging cervical cancer
Tests and procedures help doctors determine how far the cancer has spread. This is called staging and it informs the best treatment for your situation.
In Australia, cervical cancer is usually staged using the International Federation of Gynecology and Obstetrics (FIGO) staging system, which divides cervical cancer into four stages. Each stage is further divided into several sub-stages such as A, B and C.
- Early or localised cancer (stage 1) – cancer is found only in the tissue of the cervix.
- Locally advanced cancer (stage 2) – cancer has spread outside the cervix to the upper two-thirds of the vagina or other tissue next to the cervix.
- Locally advanced cancer (stage 3) – cancer has spread to the lower third of the vagina and/or the tissue on the side of the pelvis (pelvic wall). The cancer may also have spread to lymph nodes in the pelvis or abdomen, or caused a kidney to stop working.
- Metastatic or advanced cancer (stage 4) – cancer has spread to the bladder or rectum (stage 4A) or beyond the pelvis to the lungs, liver or bones (stage 4B).
Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for anyone to predict the exact course of the disease. Instead, your doctor can give you an idea about the general outlook for people with the same type and stage of cervical cancer as you.
To work out your prognosis, your doctor will consider:
- your test results
- the type of cervical cancer
- the size of the cancer and how far it has grown into other tissue
- whether the cancer has spread to the lymph nodes
- other factors such as your age, fitness and overall health.
In general, the earlier cervical cancer is diagnosed and treated, the better the outcome. Most early-stage cervical cancers have a good prognosis with high survival rates.
If cancer is found after it has spread outside the cervix (locally advanced cancer), it may still respond well to treatment and can often be kept under control. In recent years, clinical trials have led to new treatments that continue to improve the prognosis for people with metastatic cervical cancer.
Understanding Cervical Cancer
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Expert content reviewers:
Dr Pearly Khaw, Lead Radiation Oncologist, Gynae-Tumour Stream, Peter MacCallum Cancer Centre, VIC; Dr Deborah Neesham, Gynaecological Oncologist, The Royal Women’s Hospital and Frances Perry House, VIC; Kate Barber, 13 11 20 Consultant, VIC; Dr Alison Davis, Medical Oncologist, Canberra Hospital, ACT; Krystle Drewitt, Consumer; Shannon Philp, Nurse Practitioner, Gynaecological Oncology, Chris O’Brien Lifehouse and The University of Sydney Susan Wakil School of Nursing and Midwifery, NSW; Dr Robyn Sayer, Gynaecological Oncologist Cancer Surgeon, Chris O’Brien Lifehouse, NSW; Megan Smith, Senior Research Fellow, Cancer Council NSW; Melissa Whalen, Consumer.
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The information on this webpage was adapted from Understanding Cervical Cancer - A guide for people with cancer, their families and friends (2021 edition). This webpage was last updated in October 2021.