Cervical Cancer Series 09: How Is Cervical Cancer Diagnosed?
However, an abnormal screening result and a confirmed diagnosis of cervical cancer are not the same thing.
Pap and HPV tests are screening tests used to detect abnormal cervical cell changes or high-risk HPV infections associated with an increased risk of cervical cancer. Cervical cancer is definitively diagnosed by removing tissue from a suspicious area and examining it under a microscope. If cancer is found, imaging tests such as MRI, CT, or PET-CT may be used to determine the size of the cancer and how far it has spread.
The specific tests and the order in which they are performed can vary depending on your symptoms, the appearance of the cervix, and previous test results. In this article, we will look at how cervical cancer is investigated and ultimately diagnosed.
An Abnormal Screening Result Does Not Mean You Have Cervical Cancer
The HPV test and Pap test used in cervical cancer screening look for different things.
An HPV test checks for infection with high-risk types of human papillomavirus associated with cervical cancer. A Pap test collects cells from the cervix and examines them for abnormal changes.
Neither test directly confirms whether cervical cancer is present.
They are screening tests designed to identify people who may need further evaluation and to detect changes or infections associated with an increased risk of cervical cancer.
Therefore, testing positive for HPV does not necessarily mean that you have cervical cancer. Similarly, finding abnormal cells on a Pap test does not automatically lead to a cancer diagnosis.
The need for additional testing is determined by considering factors such as:
The type of cell changes found on the Pap test
Whether high-risk HPV is present and which HPV type was detected
Your age and previous screening results
Any history of precancerous cervical lesions or treatment
Any symptoms you are currently experiencing
Even if your screening results are normal, you should seek medical care if you experience symptoms that could be associated with cervical cancer, such as bleeding after sex, bleeding after menopause, or bleeding between periods.
Screening is primarily intended for people without symptoms. If you have symptoms, do not wait until your next routine screening appointment to have the cause evaluated.
The Evaluation Begins With Your Symptoms and a Cervical Examination
If cervical cancer is suspected, your healthcare provider will first review your current symptoms and previous test results.
They may ask when vaginal bleeding began, whether it occurs after sex, and whether you have experienced bleeding after menopause. They may also ask about pelvic pain or unusual vaginal discharge. Previous Pap and HPV test results, as well as any history of precancerous lesions or treatment, provide important information.
A speculum may then be used to examine the vagina and cervix directly, followed by a pelvic examination. The healthcare provider will look for visible abnormalities, areas that bleed easily, or unusual discharge.
However, a cervix that appears normal does not necessarily mean that the cells and tissues are normal. Some abnormalities cannot be seen with the naked eye, so further testing may still be necessary based on your symptoms and screening results.
If a clearly suspicious lesion is visible on the cervix, the healthcare provider may perform a biopsy without waiting for additional screening tests.
A Colposcopy Provides a Closer Look at Suspicious Areas
A colposcopy may be recommended when a Pap or HPV test indicates that further evaluation is needed or when an abnormal area is suspected on the cervix.
During the examination, a speculum is inserted into the vagina so the cervix can be seen. A solution containing acetic acid, which is similar to vinegar, may then be applied to the cervix to make suspicious changes easier to identify.
A colposcope is an instrument equipped with a bright light and magnifying lenses that allows the healthcare provider to examine the cervix in detail. The speculum is inserted into the vagina, but the colposcope itself remains outside the body.
The healthcare provider examines the magnified cervix for areas that differ in color or blood vessel pattern. If necessary, a small tissue sample is taken from a suspicious area.
The main purpose of a colposcopy is not to diagnose cancer on its own. It helps identify abnormal areas so that tissue can be collected from the most appropriate location.
After a cervical biopsy, you may experience mild cramping, light bleeding, or vaginal discharge. Contact the healthcare facility where the procedure was performed if you develop bleeding heavier than your usual period, severe pain, fever, or foul-smelling discharge.
Cervical Cancer Is Confirmed With a Biopsy
A biopsy is required to definitively diagnose cervical cancer.
During a biopsy, a small tissue sample is removed from a suspicious area of the cervix. A pathologist then examines the cells and tissue under a microscope.
The method used to collect the tissue depends on the location and extent of the abnormal area.
A punch biopsy uses a small instrument to remove a tissue sample from the surface of the cervix. It may be performed during a colposcopy.
If the abnormal area extends into the cervical canal and cannot be seen clearly, cells or tissue may need to be collected from inside the canal. Depending on the test results and location of the lesion, a loop electrosurgical excision procedure, known as LEEP or LLETZ, may be performed to remove abnormal tissue with a thin electrified wire loop.
Examining the tissue can determine whether the changes are noncancerous, a precancerous lesion such as cervical intraepithelial neoplasia, or invasive cervical cancer. If cancer is found, the pathology report may also describe its histologic type, grade, and other features relevant to treatment planning.
Cervical cancer is definitively diagnosed when cancer cells are found in a tissue sample—not simply when a suspicious area appears on an imaging test.
The result is not available immediately after the tissue is collected. The sample must be processed, stained, and examined under a microscope by a pathologist. The pathology report then becomes an important basis for deciding whether additional testing or treatment is needed.
A Cone Biopsy May Sometimes Be Needed
A small biopsy taken during colposcopy may not always provide enough information to determine the full extent of a lesion or whether it has invaded deeper tissue.
A larger tissue sample may be needed when an abnormal area extends into the cervical canal or when the results of cervical screening and biopsy do not match.
One procedure that may be used in these situations is a cone biopsy, also called conization. This procedure removes a cone-shaped piece of tissue that includes the outer cervix and part of the cervical canal.
Conization may be performed with a surgical scalpel, known as cold knife conization, or with an electrosurgical loop, depending on the location and extent of the lesion.
Examining the removed tissue can help determine:
Whether precancerous cells or cancer cells are present
How deeply and extensively cancer has invaded the tissue
Whether cancer has entered lymphatic vessels or blood vessels
Whether abnormal cells remain at the edges of the removed tissue
A cone biopsy can serve both diagnostic and therapeutic purposes. For some precancerous lesions and selected very early cervical cancers, the procedure may completely remove the abnormal tissue, allowing some patients to continue with regular follow-up rather than undergoing more extensive treatment.
However, having a cone biopsy does not necessarily mean that treatment for cervical cancer is complete. The decision to proceed with follow-up alone or additional treatment depends on factors such as the depth and extent of invasion, surgical margin status, lymphovascular invasion, histologic type, and future pregnancy plans.
Imaging Tests Evaluate the Extent of Confirmed Cancer
Once cervical cancer has been confirmed through a biopsy, imaging tests may be used to assess the size of the tumor, involvement of nearby tissues, and possible spread of the cancer to lymph nodes or other organs.
These tests may include MRI, CT, and PET-CT. Each provides different types of information.
MRI provides detailed images of the cervical tumor and surrounding structures within the pelvis. It can help evaluate the tumor’s size and its relationship to nearby tissues, including the vagina, the tissue surrounding the cervix, and the pelvic wall.
CT can examine a broader area, including the chest, abdomen, and pelvis. It may be used to evaluate nearby organs and lymph nodes and to look for possible spread to other parts of the body.
PET-CT detects areas of increased metabolic activity and may help identify lymph nodes or other organs where cancer could have spread. It may be particularly useful when locally advanced cancer or lymph node involvement is suspected.
MRI, CT, and PET-CT do not provide the definitive diagnosis of cervical cancer. They are used to evaluate the size and extent of cancer that has already been confirmed.
A suspicious finding on an imaging test does not always prove that cancer has spread. Imaging results must be interpreted together with the pathology report, physical examination, and other clinical information.
Not every patient needs all three imaging tests. The tests selected depend on the biopsy results, the estimated extent of the cancer, the patient’s symptoms, and the planned treatment.
Blood Tests Cannot Diagnose Cervical Cancer
Blood tests may be performed when cervical cancer is suspected or confirmed, but a blood test alone cannot diagnose the disease.
Blood tests are mainly used to evaluate:
Whether blood loss has caused anemia
White blood cell and platelet levels
Liver and kidney function
Electrolyte levels
Overall health and the ability to undergo further tests, surgery, or chemotherapy
Tumor marker tests may be performed in some patients, but tumor markers are not used to screen for or definitively diagnose cervical cancer.
Normal blood test results do not rule out cervical cancer, and an elevated test result does not confirm it.
Blood tests play a supportive role by helping healthcare providers understand the patient’s overall health and plan tests and treatment as safely as possible.
Diagnosis and Staging Are Based on Multiple Findings
The diagnosis of cervical cancer and the treatment plan are not based on a single test result.
Healthcare providers consider symptoms and medical history, pelvic examination and colposcopy findings, and the pathology results from a biopsy or cone biopsy. If cervical cancer is confirmed, imaging and other necessary tests are used to evaluate its extent. Blood test results and the patient’s overall health are also considered when planning treatment.
Diagnosis and staging are related but separate processes.
A biopsy determines whether cancer is present, while staging determines how advanced the confirmed cancer is and how far it has spread.
The stage is an important factor in deciding whether treatment may involve surgery, radiation therapy, chemotherapy, or a combination of approaches. Even among people with the same type of cervical cancer, treatment may differ depending on the tumor size, involvement of nearby tissues, and whether cancer has spread to lymph nodes or other organs.
In the next article, we will examine what Stage I through Stage IV cervical cancer means and how each stage affects treatment planning.
Do Not Delay Recommended Follow-Up Testing
An abnormal screening result does not automatically mean that you have cervical cancer. However, if you have been advised to undergo additional testing, it is important not to delay the evaluation.
Pap and HPV screening can identify high-risk HPV infections and abnormal cervical cell changes that may require follow-up or treatment, helping prevent cervical cancer or detect it at an early stage.
If your screening result is abnormal, do not assume that it is cancer. Instead, complete the recommended follow-up testing so the cause can be accurately identified.
Seek gynecologic care regardless of your routine screening results if you experience bleeding after sex, bleeding after menopause, or unexplained vaginal bleeding. The tests you need and the order in which they are performed may vary depending on your symptoms and previous results, so discuss the next steps with your healthcare provider.
References
National Cancer Institute. Cervical Cancer Diagnosis
https://www.cancer.gov/types/cervical/diagnosis
American Cancer Society. Tests for Cervical Cancer
https://www.cancer.org/cancer/types/cervical-cancer/detection-diagnosis-staging/how-diagnosed.html
National Cancer Institute. Cervical Cancer Screening
https://www.cancer.gov/types/cervical/screening
American College of Obstetricians and Gynecologists. Abnormal Cervical Cancer Screening Test Results
https://www.acog.org/womens-health/faqs/abnormal-cervical-cancer-screening-test-results
Chelsea and Westminster Hospital NHS Foundation Trust. What to Expect After a Biopsy of the Cervix
https://www.chelwest.nhs.uk/your-visit/patient-leaflets/womens-services/what-to-expect-after-a-biopsy-of-the-cervix
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