Colposcopy

A colposcope is specialized tool the doctor can use to closely examine the cervix. A speculum is used to hold the cervix open so the doctor can view the area with the colposcope. A vinegar or iodine solution is swabbed onto the cervix and vagina. This solution makes abnormal tissue turn white so areas that need to be evaluated can be identified. Suspicious tissue from the highlighted area will be taken for biopsy.

Biopsy

During a biopsy, suspicious tissue is removed so it can be examined under a microscope. This is the only way to confirm a diagnosis. Different biopsy methods include:

• Cone biopsy (cold cone or cold knife) —Laser or a surgical scalpel is used to remove tissue.
• Loop electrosurgical excision procedure (LEEP)—An electric wire loop is used to slice off a thin, round piece of tissue.
• Endocervical curettage—A small, spoon-shaped instrument called a curette is used to scrape tissue from inside the cervical opening.

Blood Tests

The cancer or the body's response to cancer can trigger certain changes in the blood. Blood tests may identify some of these markers in the blood. If HPV is present, blood tests can also be used to assess the specific type of human papillomavirus (HPV) that is involved.

Imaging Tests

Imaging tests may be used to look for the presence, size and location of tumors. Some tests use contrast material to highlight structures so images are more clear and detailed. Imaging tests may include:

• CT scan
• MRI scan
• PET scan
• Chest x-rays
• Intravenous pyelography —To evaluate structures in the urinary tract.

Endoscopy

A lighted scope with a camera is used to look at structures inside the body and take tissue samples. Procedures may include:

• Cystoscopy —to examine the urethra (the tube that carries urine from the body) and urinary bladder
• Sigmoidoscopy —to examine the lower colon and rectum

Surgical Staging

Pretreatment surgical staging is an procedure to determine if or how far cancer has spread beyond the cervix.

Stages of Cervical Cancer

Cervical cancer is staged from 0-4.

• Stage 0—Carcinoma in situ, CIN stage 3 —The abnormal cells are found in the innermost lining of the cervix. They have the potential to become invasive.
• Stage 1A —Microscopic cancer cells are found in cervical tissue.
  • Stage 1A1 —Cancer is 3 millimeters (mm) or less in depth AND 7 mm or less in width.
  • Stage 1A2 —Cancer is 3-5 mm in depth AND 7 mm or less in width.
• Stage 1B:
  • Stage 1B1 —Cancer can be seen WITH a microscope and is 5 mm in depth and 7 mm in width OR
  • Stage 1B2 —Cancer can be seen WITHOUT a microscope and is more than 4 centimeters (cm)
• Stage 2A —Cancer has spread beyond the cervix into the uterus, but is NOT on the pelvic wall OR the lower third of the vagina. The pelvic wall contains tissues that line the area between the hips.
  • Stage 2A1 —Cancer has spread to the vagina. Tumor can be seen WITHOUT a microscope and is 4 cm or less in size.
  • Stage 2A2 —Cancer has spread to the vagina. Tumor can be seen WITHOUT a microscope and is more than 4 cm in size.
• Stage 2B —Cancer has spread to tissues around the uterus, but is NOT on the pelvic wall.
• Stage 3A —Cancer has spread to the lower third of the vagina, but is NOT on the pelvic wall.
• Stage 3B —Cancer has spread onto the pelvic wall OR the tumor is blocking one or both of the ureters. The ureters carry urine from the kidneys to the bladder. Any obstruction may interfere with normal function.
• Stage 4A —Cancer has spread to organs close to the pelvis, such as the bladder or rectum. Any obstruction may interfere with normal function.
• Stage 4B —Cancer has spread to other parts of the body through the lymph and blood streams. Common sites for metastatic cervical cancer are lymph nodes in other parts of the body, the bones, liver, and lungs.