How is cervical cancer diagnosed?
If you have HPV infection, it does not mean you have cervical cancer. It takes about 10 to 15 years for cervical cancer to develop, and cervical cancer is a rare outcome.
If your Cervical Screening Test shows you have a type of HPV infection that requires further investigation, or abnormal cells were found that require treatment, or you have symptoms of cervical cancer (or for any other reason), you can have more tests to confirm a diagnosis of cervical cancer. These tests might include a colposcopy, a biopsy, or other types of tests.
If your Cervical Screening Test indicates a low-risk HPV infection, you do not need further investigation but you should have a repeat test in 12 months. This is because the HPV infection is likely to be cleared by your body within the next 12 months. The repeat test checks if the infection has gone and if so, you can return to five yearly screening. If the repeat test shows HPV infection is still present, you may need further investigation from a specialist.
A colposcopy is a procedure that allows the doctor to see a magnified view of the cervix, vagina and vulva. This can help identify where abnormal or changed cells are and what they look like. The doctor will probably also take a tissue sample (biopsy) during the procedure.
The doctor will use an instrument called a colposcope. This looks like a pair of binoculars sitting on a large stand. It does not enter your body – the doctor inserts a device called a speculum into your vagina and views a magnified picture of the cervix, vagina and vulva through the colposcope.
Before the test, the doctor may coat your vagina and cervix with a liquid that will help highlight any abnormal areas. You may experience some mild discomfort during the procedure, which may take 15–30 minutes.
Some colposcopes are fitted with a camera, which is connected to a TV screen. This may allow you to watch what the doctor is doing. You should feel free to ask the doctor to explain what is happening.
A biopsy is when your doctor removes some cervical tissue and sends it to the laboratory for examination under a microscope. When the tissue is removed, you may feel uncomfortable for a short time.
Biopsies are usually performed in the examination room or in a clinic. The results should be back from the laboratory within about 1 week.
After a biopsy, you may experience some pain, similar to menstrual cramping. You can ask for medication to relieve the pain. You may also have some bleeding or other vaginal discharge, but these side effects will gradually disappear.
To allow the cervix to heal after a biopsy and to reduce the chance of infection, you should not have sex or use tampons for at least a few days.
If the biopsy shows that you have cervical cancer, a number of other tests may be done. These will determine the extent of the cancer in your cervix and whether it has spread (metastasised) to other parts of the body. This is called staging, and will help you and your doctor decide on the best treatment for you.
You may have 1 or more of the following tests.
You may have blood tests to assess your general health and to help with making decisions about your treatment.
Chest X-rays can help identify whether the cancer has spread to the lungs.
A computerised tomography (CT) scan is a type of X-ray procedure that takes pictures of the inside of your body. This painless test will help your doctor assess if the cancer has spread to the lymph nodes or to other organs.
You may be asked to drink a liquid (called contrast fluid) or have a tampon inserted into your vagina before the scan. These will help to give a clearer picture.
Sometimes a special liquid is also put into your rectum before the scan. This may make you feel hot all over for a few minutes.
A CT scan takes about 30–40 minutes. You will lie flat on a table while the CT scanner, which is large and round like a doughnut, rotates around you and takes a series of pictures.
After the scan, you can usually go home.
People who are allergic to iodine may also be allergic to the dye used in a CT scan. If you think you may have such an allergy, tell your doctor before the scan.
A magnetic resonance imaging (MRI) scan uses a powerful magnet linked to a computer to take detailed pictures of areas inside the body. The pictures are taken while you lie on a table that slides into a metal cylinder.
An MRI scan is painless, but some people find that lying in the cylinder is noisy and uncomfortably small. You can sometimes request someone in your room for company. If you feel uncomfortable, let your doctor or nurse know – they can give you medication to ease this feeling.
The scan takes less than 1 hour, and most people can go home as soon as it is over.
You might have a positron emission tomography (PET) scan. PET scans are similar to CT scans – in fact, PET and CT scanners are often combined within the same machine.
Before the scan, you will be injected with a liquid that contains a small amount of radioactive material. This takes 30–50 minutes to spread throughout your body. Cancerous cells will take up more of the liquid than normal cells and will appear brighter in the scan.
The scan takes about 1 hour.
Examination under general anaesthetic
You may be given a general anaesthetic so your vagina, cervix, bladder and rectum can be carefully examined. The doctor will insert a narrow instrument called a cystoscope into your urethra to examine your bladder. A biopsy may also be taken during this examination.
You may also have some of the cells in your uterus removed for examination. The process of removing the lining of the uterus (endometrium) is called a dilation and curettage (D&C). After a D&C, bleeding is common for a few days.
Grading and staging
Knowing the grade and stage of the cancer helps you and your doctors to decide on the most appropriate treatment.
The grade of a cancer refers to how similar the cancer cells are to normal cells. Low-grade tumours tend to grow more slowly and are usually easier to treat. High-grade tumours grow faster and spread more quickly.
A pathologist grades cervical cancer using cells or tissue from a biopsy.
The stage of a cancer refers to how far the cancer has spread. The staging system used for cervical cancer is the FIGO system, developed by the International Federation for Gynecology and Obstetrics:
- Stage 0: the cancer is confined to the surface layers (cells lining the cervix). This is also known as carcinoma in situ.
- Stage 1: the cancer has grown deeper into the cervix but has not spread beyond it.
- Stage 2: the cancer has spread beyond the uterus but has not spread to the pelvic wall or lower part of the vagina.
- Stage 3: the cancer has spread to the pelvic wall or the lower part of the vagina.
- Stage 4: the cancer has spread beyond the pelvis, involves the bladder or the rectum or has spread to more distant organs.