Cancer Cervix Evaluation
An evaluation of cervical cancer begins with a medical history and physical examination.
Usually, there are no physical findings in women with cervical cancer.
The diagnosis of cervical cancer must be confirmed through testing.
Tests that may be used to evaluate cervical cancer include:
- PAP smear:
- Cells from this specimen are analyzed under a microscope to look for cancer cells.
- Cervical biopsy:
- Used to obtain a tissue specimen for analysis.
- HPV testing
Once cancer is detected, additional tests that may be used to evaluate cervical cancer include:
Cancer Cervix Biopsy
Tissue samples can be obtained by three different methods:
- Cone biopsy or conization: a cone-shaped piece of tissue is removed using a scalpel, laser, electrocautery (heat), or loop electrosurgical excisional device. In this last method the doctor removes tissue with a thin wire loop and a tightly controlled current of electricity. Cone biopsy not only provides a specimen for study under the microscope, but it is also a form of treatment since it may completely remove the cancer from the cervix.
- Endocervical curettage: the doctor uses a small instrument to scrape tissue from the canal of the cervix. This is an area, which can't be seen with colposcopy.
- Punch biopsy: the doctor removes a tiny piece of cervical tissue while looking though the colposcope.
Cancer Cervix Colposcopy
An abnormal area may be visible on the surface of the cervix that is irregular and prone to bleeding. A sore or ulceration on the surface of the cervix or an abnormal PAP smear result may require a biopsy procedure. Colposcopy with cervical biopsy are necessary to confirm the diagnosis of cervical cancer and determine the staging (extent of spread).
Colposcopy is a special viewing tube that contains a light and a magnifying lens. This device helps to guide the biopsy.
Cancer Cervix HPV Testing
Vaginal swabs are tested for the presence of human papillomavirus (HPV). The HPV test is a newer molecular test that is done on the sample of cervical cells by an automated system that detects the genetic code of the HPV virus.
Cancer Cervix PAP Smear
The PAP smear is a simple, painless test, where the examiner brushes off the surface of the cervix with a wooden spatula. The PAP smear is performed during a pelvic examination. The sample cells that are collected during the process are evaluated for the presence of cancer. The PAP test is very sensitive and can show early or pre-cancerous changes referred to as cervical dysplasia.
Cancer Cervix Staging
Cervical Cancer Staging
If cervical cancer is detected, it is important to determine to what degree the cancer may have spread. The process of making these determinations is referred to as staging. Staging is important because it plays a major role in determining the most effective course of treatment.
A number of tests may be required to determine the cancer stage.
Cancer Cervix Stage 0
Cancer Cervix Stage 1
- Stage 1A: A very small amount of cancer that can only be seen with a microscope is found in the tissues of the cervix. The cancer is not deeper than 5 millimeters and not wider than 7 millimeters.
- Stage 1B: In stage 1B, cancer is still within the cervix and either:
- Can only be seen with a microscope and is deeper than 5 millimeters or wider than 7 millimeters; or
- Can be seen without a microscope and may be larger than 4 centimeters.
Cancer Cervix Stage 2
Cancer Cervix Stage 3
Cervical Cancer Stage 3
In stage 3, cancer has spread to the lower third of the vagina and may have spread to the pelvic wall and nearby lymph nodes.
Stage 3 is divided into stages 3A and 3B, based on how far the cancer has spread:
- Stage 3A: Cancer has spread to the lower third of the vagina but not to the pelvic wall.
- Stage 3B: Cancer has spread to the pelvic wall and-or the tumor has become large enough to block the ureters. This blockage can cause the kidneys to enlarge or stop working. Cancer cells may also have spread to lymph nodes in the pelvis.
Cancer Cervix Stage 4
Continue to Cancer Cervix Treatment
- Eddy DM: Screening for cervical cancer. Ann Intern Med 1990 Aug 1; 113(3): 214-26. 
- Ellenson LH, Wu TC. Focus on endometrial and cervical cancer. Cancer Cell. 2004 Jun;5(6):533-8. 
- Schiffman MH, Bauer HM, Hoover RN: Epidemiologic evidence showing that human papillomavirus infection causes most cervical intraepithelial neoplasia. J Natl Cancer Inst 1993 Jun 16; 85(12): 958-64. 
- Sundar S, Horne A, Kehoe S. Cervical cancer. Clin Evid. 2005 Jun;(13):2285-92. 
- Waxman AG. Guidelines for cervical cancer screening: history and scientific rationale. Clin Obstet Gynecol. 2005 Mar;48(1):77-97.