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Diagnosis of Cervical Cancer

The doctor will ask about a person's symptoms, health, and family history. A pelvic exam will be done. A pelvic exam is an exam of the vagina, cervix, uterus, fallopian tubes, and ovaries. A Pap test will also be done. This test takes a sample of cervical tissue for testing. This may be done even if there are no symptoms.

Suspicion and Diagnosis of Cervical Cancer

If the Pap test shows abnormal cervix cells, other tests will need to be done. These may include:

Colposcopy

A colposcope is special tool the doctor can use to check the cervix. A speculum is used to hold the cervix open. This helps 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. Tissue from the highlighted area will then be taken for a biopsy.

Biopsy

During a biopsy, suspicious tissue is removed. It is then examined under a microscope. This is the only way to confirm a diagnosis. Different biopsy methods are:

Squamous Cell Carcinoma of the Cervix

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Staging of Cervical Cancer

If cervical cancer is found, other tests are needed to find the stage of the cancer. Staging outlines how far and fast the cancer has spread. It helps the doctor determine the treatment and the recovery.

Tests that may help determine cervical cancer stage are:

Blood Tests

Cancer can trigger certain changes in the blood. Blood tests can help to find them. If human papillomavirus (HPV) is found, blood tests can also show what type of HPV it is.

Imaging Tests

Imaging tests may be used to look for tumors. Imaging tests may include:

Endoscopy

Endoscopy may be used to see if cancer is in other areas. A lighted scope with a camera is used to look 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

Sometimes pretreatment surgical staging is done. This is a procedure to find out if cancer has spread beyond the cervix.

Stages of Cervical Cancer

Cervical cancer is staged from 1 to 4.

  • Stage 1A —Cancer cells are found only in the cervix. It can only been seen with a microscope.
    • Stage 1A1 —There is a small amount of cancer. It has not spread. It is less than 3mm deep.
    • Stage 1A2 —The cancer is a little deeper. It has not spread. It is 3mm to 5 mm deep.
  • Stage 1B — The cancer is a little bit larger but is still in the cervix.
    • Stage 1B1 —The cancer is deeper than 5 mm but not more than 2 cm.
    • Stage 1B2 —Cancer can be seen WITHOUT a microscope. The cancer is at least 2 cm in size but no more than 4 cm.
  • Stage 2A — The cancer has started to spread outside the cervix. It has spread to the top of the vagina. It has not spread to lymph nodes or distant areas.
    • Stage 2A1 —The tumor is 4 cm or less in size.
    • Stage 2A2 —The tumor is more than 4 cm in size.
  • Stage 2B —Cancer has spread to tissues around the cervix, 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.
  • Stage 3C —Cancer has spread to nearby lymph nodes.
  • Stage 4A —Cancer has spread to organs near the pelvis, such as the bladder or rectum.
  • Stage 4B —Cancer has spread to other parts of the body. It may be in lymph nodes in other parts of the body, the bones, liver, and lungs.
REFERENCES:

Bhatla N, Berek JS, et al. Revised FIGO staging for carcinoma of the cervix uteri. Int J Gynaecol Obstet. 2019 Apr;145(1):129-135.

Cervical cancer. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/cervical-cancer. Accessed April 22, 2021.

Cervical cancer. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/gynecology-and-obstetrics/gynecologic-tumors/cervical-cancer. Accessed April 22, 2021.

Stages of cervical cancer. National Cancer Institute website. Available at: https://www.cancer.gov/types/cervical/patient/cervical-treatment-pdq#section/_142. Accessed April 22, 2021.

Tests for cervical cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/cervical-cancer/detection-diagnosis-staging/how-diagnosed.html. Accessed April 22, 2021.

Last reviewed March 2021 by EBSCO Medical Review Board Mohei Abouzied, MD, FACP  Last Updated: 4/22/2021