Screening Test and Cervical Cancer Detection
The symptoms of cervical cancer generally appear in the advanced stage, while the early stages are largely asymptomatic (without symptom). Early diagnosis greatly increases the success of the prescribed treatment and therefore the prognosis. Read more on cervical cancer prognosis.
Symptoms such as abnormal vaginal bleeding and pelvic pain, which are often neglected, should be taken into account and investigated. Routine screening is the ideal approach and regular pap smears can detect pre-cancerous changes. Women who are at risk should ensure more regular visits and specialized screening measures. Read more on cervical cancer risks.
Physical examination, including a speculum pelvic examination is important for detection of cancerous lesions. Small tumors or those located lesions higher up in the cervix cannot always be visualized by means of a speculum examination. In most cases, though, the growth may be visible.
The Pap smear or Pap test (Papanicolaou test or) is a screening test which is extremely helpful in detecting pre-invasive form of the disease. Regular Pap tests are recommended for all women who are sexually active or from the age of 20. Women who pass menopause (post-menopausal) should also continue to have regular Pap tests.
Having regular Pap tests is crucial not only for early detection of cervical cancer but also in finding abnormal or pre-cancerous cells that can become cancerous later on. Treatment at the pre-cancerous stage can prevent development of cervical cancer in most cases, while treatment of early invasive carcinoma can result in complete cure of the cancer.
A Pap test is usually done while conducting a pelvic examination. Cells from the cervix are scraped out by means of a small spatula, cotton swab, or a soft brush and examined under the microscope. Results are most accurate when the smear is obtained from the squamocolumnar junction or the transformation zone between the endocervix and exocervix.
The Pap test results, if abnormal, may be followed up with other tests.
An HPV test may be done along with a Pap test when the latter shows an abnormal test result. It may also be done in women over the age of 30 as a screening test to detect high-risk types of HPV (human papillomavirus) which can cause cervical cancer. Detection of high-risk strains of HPV even without any abnormal cell changes may be considered as a warning sign for cervical cancer and should be managed accordingly.
An abnormal result obtained by a Pap test does not necessarily mean that it is cancer. Abnormal Pap tests may indicate other conditions, such as genital warts or infections. However, if the Pap test is abnormal, a colposcopy is usually the next step.
A colposcopy is done by means of an instrument, known as the colposcope, which is placed just outside the vaginal opening. The colposcope is a magnifying instrument, like a microscope, with a light at its end, which allows better visualization of the cervix. Any abnormal area seen during colposcopy may be investigated further by taking a biopsy of that area.
A biopsy may be taken from any abnormal area which is seen during colposcopy. The removed sample is sent to the laboratory to be examined under the microscope.
A biopsy may be taken by various means, such as :
- Punch biopsy is an instrument used to punch out a small piece of the abnormal cervical tissue.
- Endocervical curettage is where the cells from the cervical canal may be taken by means of a curette or a soft brush.
- Conization or cone biopsy is where a cone-shaped tissue sample is removed, which allows for examination of the deeper tissues of the cervix for abnormal cells. This is usually done when colposcopic results are inconclusive or microinvasive cancer is suspected. Conization is not advisable for frank cancerous lesions because of the risk of hemorrhage. Cold knife conization and laser conization may be preferred. In loop electrosurgical excision procedures (LEEP), an electric wire loop is used to slice off samples of cervical tissue.
Metastasis to the lungs may be detected upon conducting a chest x-ray.
CT Scan and MRI
A CT scan or an MRI is usually done to detect spread of cancer to other organs, such as the liver or lungs.