How is cervical cancer diagnosed?

Signs and symptoms of cervical cancer

Women with early cervical cancers and pre-cancers usually have no symptoms. Symptoms often do not begin until the cancer becomes invasive and grows into nearby tissue. When this happens, the most common symptoms are:

• Abnormal vaginal bleeding, such as bleeding after sex (vaginal intercourse), bleeding after menopause, bleeding and spotting between periods, and having (menstrual) periods that are longer or heavier than usual. Bleeding after douching, or after a pelvic exam is a common symptom of cervical cancer but not pre-cancer.

• An unusual discharge from the vagina — the discharge may contain some blood and may occur between your periods or after menopause.

• Pain during intercourse.

These signs and symptoms can also be caused by conditions other than cervical cancer. For example, an infection can cause pain or bleeding. Still, if you have any of these signs or other suspicious symptoms, you should see your health care professional right away. Ignoring symptoms may allow the cancer to progress to a more advanced stage and lower your chance for effective treatment.

Even better, don’t wait for symptoms to appear. Have regular Pap tests and pelvic exams.

Your primary doctor can often treat pre-cancers. If there is a question of invasive cancer, your doctor will refer you to a gynecologic oncologist, a doctor who specializes in women’s reproductive system cancers. Some patients will also be referred to a radiation oncologist, a doctor who specializes in treating cancers with radiation.

Diagnostic tests for cervical cancer

Many of the diagnostic tests described below are not necessary for every patient. Decisions about using these tests are based on the results of the physical exam and biopsy.

Medical history and physical exam

Getting your complete personal and family medical history is the first step your doctor will take in your consultation. This includes information related to risk factors and symptoms of cervical cancer. A complete physical exam will help evaluate your general state of health. In addition, special attention will be paid to your lymph nodes for evidence of metastasis (cancer spread).

Cystoscopy, proctoscopy, and examination under anesthesia

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

In cystoscopy a slender tube with a lens and a light is placed into the bladder through the urethra. This lets the doctor check your bladder and urethra to see if cancer is growing into these areas. Biopsy samples can be removed during cystoscopy for pathologic (microscopic) testing. Cystoscopy can be done under a local anesthetic, but some patients may need general anesthesia. Your doctor will let you know what to expect before and after the procedure.

Proctoscopy is a visual inspection of the rectum through a lighted tube 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 whether the cancer has spread beyond the cervix.

Imaging studies

If your doctor finds that you have cervical cancer, certain imaging studies may be done. These include magnetic resonance imaging (MRI) and computed tomography (CT) scans. These studies 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 very unlikely unless your cancer is far advanced. This x-ray can be done in an outpatient setting. If the results are normal, you probably don’t have cancer in your lungs.

Computed tomography (CT): The CT scan is an x-ray procedure that produces detailed cross-sectional images of your body. Instead of taking one picture, like a conventional x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines these pictures into an image of a slice of your body (think of a loaf of sliced bread). The machine takes pictures of multiple slices of the part of your body that is being studied. CT scans can help tell if your cancer has spread to the lymph nodes in the abdomen and pelvis. They are also used to see if the cancer has spread to the liver, lungs, or elsewhere in the body.

Before the first set of pictures is taken you may be asked to drink 1 to 2 pints of a contrast liquid. You may also receive an IV (intravenous) line through which a different kind of contrast is injected. This helps better outline structures in your body.

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 occur. You can be given medicine to prevent and treat allergic reactions, so be sure to tell your doctor if you have ever had a reaction to contrast material 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. But just like other computerized devices, they are getting faster and your stay might be pleasantly short. The newest CT scanners take only seconds to complete the study. Also, you might feel a bit confined by the ring-like equipment you’re in when the pictures are being taken.

CT scans are sometimes used to guide a biopsy needle precisely into an area of suspected cancer spread. For this procedure, called a CT-guided needle biopsy, the patient remains on the CT scanning table while a radiologist advances a biopsy needle toward the location of the mass. CT scans are repeated until the doctors are confident that the needle is within the mass. A fine needle biopsy sample (tiny fragment of tissue) or a core needle biopsy sample (a thin cylinder of tissue about ½-inch long and less than 1/8-inch in diameter) is removed and examined under a microscope.

Magnetic resonance imaging (MRI): MRI scans use radio waves and strong magnets instead of x-rays to take pictures. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases. A computer translates the pattern of radio waves given off by the tissues into a very detailed image of parts of the body. Not only does this produce cross sectional slices of the body like a CT scanner, it can also produce slices that are parallel with the length of your body.

MRI images are particularly useful in examining pelvic tumors. They are also helpful in detecting cancer that has spread to the brain or spinal cord.

A contrast material might be injected just as with CT scans, but is used less often. MRI scans take longer than CTs — often up to an hour. Also, you have to be placed inside a tube-like piece of equipment, which is confining and can upset people with claustrophobia (a fear of enclosed spaces). The machine makes a thumping noise that some people find disturbing. Some places provide headphones with music to block this noise out. A mild sedative is helpful for some people.

Intravenous urography: Intravenous urography (also known as intravenous pyelogram, or IVP) is an x-ray of the urinary system taken after a special dye is injected into a vein. This dye is removed from the bloodstream by the kidneys and passes into the ureters and bladder (the ureters are the tubes that connect the kidneys to the bladder). This test finds abnormalities in the urinary tract, such as changes caused by spread of cervical cancer to the pelvic lymph nodes, which may compress or block a ureter. IVP is rarely used currently to evaluate patients with cervical cancer. You will not usually need an IVP if you have already had a CT or MRI.

Positron emission tomography: Positron emission tomography (PET) uses glucose (a form of sugar) that contains a radioactive atom. Cancer cells in the body absorb large amounts of the radioactive sugar and a special camera can detect the radioactivity. This test can help see if the cancer has spread to lymph nodes. PET scans are also useful when your doctor thinks the cancer has spread but doesn’t know where. PET scans can be used instead of several different x-rays because they scan your whole body. Newer devices combine a CT scan and a PET scan to even better pinpoint the tumor. This test is rarely used for patients with early cervical cancer, but may be used to look for more advanced disease.