Cervical Cancer Overview

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Early Detection, Diagnosis, and Staging TOPICS

How is cancer of the cervix found?

Signs and symptoms of cervical cancer

Early cervical pre-cancers or cancers often have no signs or symptoms. That's why it's important for women to have regular screening with a Pap test (which may be combined with a test for HPV). Symptoms often do not start until the cancer is further along and has spread to nearby areas. You should report any of the following to your doctor right away:

  • Abnormal vaginal bleeding, such as bleeding after sex, bleeding after menopause, bleeding and spotting between periods, or having periods that are longer or heavier than usual. Bleeding after douching or after a pelvic exam may also occur.
  • An unusual discharge from the vagina (not your normal period)
  • Pain during sex

Of course, these symptoms do not mean that you have cancer. They can also be caused by something else. But you must check with a doctor to find out.

It is best to not wait for symptoms to appear. Get regular cervical cancer screening.

Tests that look for cervical cancer and pre-cancer

Medical history and physical exam

The doctor will ask you about your health, your risk factors, and about the health of your family members. A complete physical exam will be done with special attention to your lymph nodes to look for any signs that cancer has spread. The doctor will do a pelvic exam and may do a Pap test if you haven't already had one.

The Pap test is a screening test, not a diagnostic test. An abnormal Pap test result might mean that you need another test to find out if a cancer or a pre-cancer is really there. The most common test is colposcopy.

Colposcopy

If you have certain symptoms that suggest cancer or if your Pap test shows abnormal cells, you will need to have a test called colposcopy. The doctor will use a colposcope to look at your cervix. The colposcope is an instrument that stays outside the body. It has magnifying lenses (like binoculars). It lets the doctor see the surface of the cervix closely and clearly.

Colposcopy itself is not painful, has no side effects, and can be done safely even if you are pregnant. Like the Pap test, it is rarely done during your period. If something not normal is seen on the cervix, a biopsy will be done. For a biopsy, a small piece of tissue is removed from the place that looks abnormal. The sample is sent to be looked at under a microscope. A biopsy is the only way to tell for certain whether something is a pre-cancer, a true cancer, or neither. Although the colposcopy procedure is not painful, cervical biopsy can cause discomfort, cramping, or even pain in some women.

Several different types of biopsies are used to diagnose cervical pre-cancers and cancers. Ask your doctor to explain what kind of biopsy you will have and what the results mean.

If a biopsy shows that cancer is present, your doctor may order certain tests to see how far the cancer has spread. Many of the tests described below are not needed for every patient. Which tests are done is based on the results of the physical exam and biopsy.

Tests that look for cervical cancer spread

Cystoscopy, proctoscopy, and exam under anesthesia

These are most often done in women who have large tumors. They are not needed if the cancer is caught early.

In cystoscopy a thin tube with a lens and a light is put into the bladder through the urethra. This lets the doctor check to see if cancer is growing into these areas. Biopsy samples can also be removed. Cystoscopy can be done under a local anesthetic (the area is numbed with drugs), but some patients may need general anesthesia (drugs that put you in a deep sleep). Your doctor will let you know what to expect before and after the tests.

For proctoscopy a thin, lighted tube is used to check for spread of cervical cancer into your rectum.

Your doctor may also do a pelvic exam while you are under anesthesia to find out if the cancer has spread beyond the cervix.

Methods used to get pictures of the inside of the body (imaging studies)

If your doctor finds that you have cervical cancer, imaging studies may be used to create pictures of the inside of your body. They can show whether the cancer has spread beyond the cervix.

Chest x-ray: A plain x-ray of your chest will be done to see if your cancer has spread to your lungs. This is not likely unless your cancer is very advanced. If the results are normal, you most likely don’t have cancer in your lungs.

CT scan (computed tomography): The CT scan is a special kind of x-ray. Instead of taking just one picture, a CT scanner takes many pictures as it moves around you. A computer then combines these pictures into an image of a slice of your body (think of a loaf of sliced bread).

CT scans can help tell if your cancer has spread to other places in the body. CT scans are also sometimes used to guide a biopsy needle into a place where the cancer might have spread. A biopsy (tiny sample or thin core of tissue) is removed and looked at under a microscope.

Before the first set of CT pictures is taken you may be asked to drink some liquid that helps outline structures in your body. You might also have an IV line through which you may be given a different kind of contrast dye.

The IV contrast can cause your body to feel flushed (a feeling of warmth with some redness of the skin). A few people are allergic to the dye and can get hives. Rarely, more serious reactions, like trouble breathing and low blood pressure, can happen. Be sure to tell your doctor if you have ever had a reaction to contrast dye used for x-rays. It is also important to let your doctor know about any other allergies.

CT scans take longer than regular x-rays and you will need to lie still on a table while they are being done. Also, you might feel a bit confined by the ring-like equipment you're in when the pictures are being taken.

MRI scans (magnetic resonance imaging): MRI scans use radio waves and strong magnets instead of x-rays to take pictures. MRI images are very useful in looking at pelvic tumors. They are also helpful in finding cancer that has spread to the brain or spinal cord.

An MRI scans take longer than CT scans − often up to an hour. Also, you have to be placed inside a narrow, tube-like machine, which can upset some people. Special, “open” MRI machines may be an option for some patients; the downside of these is that the images may not be as good. The machine makes a thumping noise that you might find annoying. Some places will give you headphones with music to block this out.

PET scan (positron emission tomography): PET scans use glucose (a form of sugar) that contains a radioactive atom. Cancer cells in the body absorb large amounts of the treated sugar and a special camera can spot the cells. Some machines combine a CT scan and a PET scan to even better pinpoint the tumor. This test can help show whether the cancer has spread to lymph nodes. PET scans can also be useful when your doctor thinks the cancer has spread but doesn't know where.


Last Medical Review: 04/24/2013
Last Revised: 01/31/2014