Cervical Cancer Diagnosis

If you have symptoms or screening test results that suggest the possibility of cervical cancer, your doctor will do follow-up tests to find out if it is due to cancer or some other cause. They will usually start by asking about your personal and family medical history and by doing a physical exam, which will include a pelvic exam and rectovaginal exam. They may recommend diagnostic tests to find out if you have cervical cancer, and if so, whether it has spread to another part of the body. The results of these tests will also help you and your doctor plan treatment.

How cervical cancer is diagnosed

The following procedures are used to diagnose cervical cancer:

Colposcopy

Colposcopy is a procedure in which the health care provider inserts a speculum to gently open the vagina and view the cervix. A vinegar solution will be applied to the cervix to help show abnormal areas. The health care provider then places an instrument called a colposcope close to the vagina. It has a bright light and a magnifying lens and allows the health care provider to look closely at the cervix. A colposcopy usually includes a biopsy.

Biopsy

Biopsy is a procedure in which a sample of tissue is removed from the cervix so that a pathologist can view it under a microscope to check for signs of cancer. The following types of biopsies are used to check for cervical cancer:

• Punch biopsy is a procedure in which a small, round piece of tissue is removed using a sharp, hollow circular instrument. Sometimes several different areas of the cervix will be checked with punch biopsy. This procedure is usually done in the doctor’s office.
• Endocervical curettage is a procedure to collect cells or tissue from the cervical canal using a curette (spoon-shaped instrument). This procedure removes only a small amount of tissue and is usually done in the doctor’s office.
• Loop electrosurgical excision procedure (LEEP) uses a thin wire loop, through which an electrical current is passed, to remove tissue from the cervix. LEEP may be used to diagnose cervical cancer. It also may be used to remove precancer or early-stage cancer. This procedure is typically done in a doctor’s office. It usually takes only a few minutes, and local anesthesia is used to numb the area.
• Cone biopsy is surgery to remove a larger, cone-shaped piece of tissue from the cervix and cervical canal. A cone biopsy may be used to diagnose cervical cancer. It also may be used to remove precancer or early-stage cancer. This procedure is also called conization. A cone biopsy is done at the hospital under general anesthesia.

Talk with your health care provider to learn what to expect during and after your biopsy procedure. Some people have bleeding and/or discharge after a biopsy. Others have pain that feels like cramps during menstruation.

To learn about the type of information that can be found in a pathologist’s report about the cells or tissue removed during a biopsy, see Pathology Reports.

Tests and procedures used to stage cervical cancer

If you are diagnosed with cervical cancer, you will be referred to a gynecologic oncologist. This is a doctor who specializes in staging and treating cervical cancer and other cancers of the female reproductive system. They will recommend tests to determine the extent (stage) of cancer. Sometimes the cancer is only in the cervix. Or, it may have spread from the cervix to other parts of the body. The process of learning the extent of cancer in the body is called staging. It is important to know the stage of the cervical cancer in order to plan the best treatment.

For information about a specific stage of cervical cancer, see Cervical Cancer Stages.

The following procedures may be used to determine the cervical cancer stage:

Imaging tests

• PET-CT scan combines the pictures from a positron emission tomography (PET) scan and a computed tomography (CT) scan. The PET and CT scans are done at the same time on the same machine. The pictures from both scans are combined to make a more detailed picture than either test would make by itself.
  • For the PET scan, a small amount of radioactive glucose (sugar) is injected into a vein. The scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells.
  • For the CT scan, a series of detailed x-ray pictures of areas inside the body is taken from different angles. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly.
• Magnetic resonance imaging (MRI) uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging.
• Ultrasound uses high-energy sound waves (ultrasound), which bounce off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
• Chest x-ray is an x-ray of the organs and bones inside the chest. An x-ray is a type of high-energy radiation that can go through the body and onto film, making a picture of areas inside the chest.

Lab tests

• Complete blood count (CBC) is a blood test that measures the following in a sample of blood:
  • the number of red blood cells, white blood cells, and platelets
  • the amount of hemoglobin (the protein that carries oxygen) in the red blood cells
  • the portion of the blood sample made up of red blood cells
• Blood chemistry study is a blood test that measures the amounts of certain substances released into the blood by organs and tissues in the body, including electrolytes, lactate dehydrogenase, uric acid, blood urea nitrogen, creatinine, and liver function values. An unusual (higher or lower than normal) amount of a substance can be a sign of cancer spread or other diseases.

Visual examination

• Cystoscopy is a procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope is inserted through the urethra into the bladder. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
• Sigmoidoscopy uses a sigmoidoscope to look inside the rectum and sigmoid (lower) colon for abnormal areas. A sigmoidoscope is inserted through the rectum into the sigmoid colon. A sigmoidoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.

Getting a second opinion

Some people want to get a second opinion to confirm their cervical cancer diagnosis and treatment plan. If you choose to seek a second opinion, you will need to get important medical test results and reports from the first doctor to share with the second doctor. The second doctor will review the pathology report, slides, and scans before giving a recommendation. The doctor who gives the second opinion may agree with your first doctor, suggest changes or another approach, or provide more information about your cancer.

For questions you might want to ask at your appointments, see Questions to Ask Your Doctor.

To learn more about choosing a doctor and getting a second opinion, see Finding Cancer Care. You can also contact NCI’s Cancer Information Service via chat, email, or phone (both in English and Spanish) for help finding a doctor, hospital, or getting a second opinion.