Cervical Cancer:
Diagnosis and Staging

This page covers tests that are often used to help diagnose and stage cervical cancer.
Depending on the symptoms you have, you may also be asked to undergo other tests and investigations.
Diagnostic Tests to Determine Cancer Type

Once the doctor is sure of an abnormality, the following tests are done to determine further details about the type of cancer present.

Colposcopy

What to expect

If you have symptoms that suggest cervical cancer, or if your Pap test shows abnormal results, your physician may recommend a procure called a colposcopy.

A colposcopy is generally pain-free, unless you have an underlying condition that causes pain to your pelvic area. You can expect some minor discomfort while undergoing the test. It is important that you choose a doctor and clinical team that you are comfortable with to perform your test. Your clinician may tell you to avoid doing the test during your menstrual period.

During a colposcopy,

  • You will first be asked to undress the lower part of your body and lie on the examination table. Ask for a sheet or blanket to cover yourself while you wait for your doctor.

  • Try to relax your pelvic area, as this will make the test more comfortable for you.

  • Your doctor will first place a speculum inside your vaginal opening. The speculum is a metal or plastic instrument that keeps the vagina open so that the cervix can be seen clearly and examined using a colposcope. A colposcope is a magnifying instrument used to check for abnormal tissue.

  • In order to make any abnormal areas easier to see, your doctor will put a weak solution of acetic acid (similar to vinegar) on your cervix.

  • If any abnormal areas are seen, your doctor may recommend that a biopsy be done.

Biopsy

What to expect

A biopsy is usually the best way to tell for certain if an abnormal area is cancerous or not and is usually done immediately after the colposcopy. This procedure involves collecting a sample of cervical tissue for further analysis in a lab.

While the colposcopy procedure is generally painless, a cervical biopsy can cause discomfort, bleeding or even pain. There are several types of biopsies to diagnose cervical cancers.

  • Colposcopic biopsy: In this type of biopsy, your doctor will use a sharp tool called a biopsy forceps to remove a small sample of cervical tissue. This procedure may cause mild cramping, brief pain and slight bleeding afterward.
  • Endocervical curettage: In this procedure, a small, spoon-shaped instrument or a thin brush is inserted into the endocervical canal and used to scrape a tissue sample from the cervix. After this procedure, you may feel a cramping pain and experience light bleeding afterward.
  • Cone biopsy: A cone biopsy or conization is a procedure that allows your doctor to obtain samples of deeper layers of cervical cells for lab testing. Your doctor will remove a cone-shaped piece of tissue from the cervix. There are two methods used:
    • Loop electrosurgical procedure: This method uses a thin, low-voltage electrified wire to obtain the tissue sample. Your doctor will normally use local anaesthesia to complete this procedure.
    • Cold-knife cone biopsy: In this method, a surgical scalpel or laser is used to remove the tissue instead of the electrified wire. You will receive general anaesthesia during this operation.

Diagnostic Tests to Determine
Stage and Spread of Cancer

Bone Scan

What to expect

A bone scan is a type of imaging study and is generally painless. During the scan, an image of the bones is taken. It is typically more sensitive than an X-ray. It is important that you choose a doctor and clinical team that you are comfortable with to perform scan.

You may be asked to refrain from eating or drinking for a few hours before your scan. Be sure to inform your doctor prior to your scan if

You are pregnant or breastfeeding

You have previously had an allergic
reaction to contrast material

You are taking any vitamins, ayurvedic
medicines or homeopathic medicines

During a bone scan:

You may be asked to change into a hospital gown and remove your jewellery, watch, body piercings or any other accessory that contains metal. You may also be asked to empty your bladder.

You may be given a special dye (called contrast material) which can help highlight the bones of your body. The dye is typically administered by injection through a vein in your arm. You may need to wait for a few hours for your body to absorb the dye. Your doctor may ask you to drink plenty of fluids while you wait.

Next, a nurse or technician will take you to the room which contains the bone scanner. You will be asked to lie on a narrow table. The nursing staff may use straps to keep you in position. You can ask for a pillow if you are feeling uncomfortable. You will be asked to remain still for the duration of the scan.

During the scan, a device that has a sensitive camera will pass back and forth over your body.

The technicians will be seated in a separate room, but they will be able to see and hear you. You may be asked to communicate with them via intercom. They may ask you to hold your breath at certain times to improve image quality.

The scan will usually take 30 minutes to an hour to complete.

After the scan, you may receive special instructions regarding the contrast material. For example, your technician or doctor may ask you to wait for a few minutes to ensure that you do not have an allergic reaction. You may also be told to drink plenty of fluids to help your kidneys flush out the contrast material through your urine.

CT Scan

What to expect

A CT (computerized tomography) scan is an imaging study and is generally painless. It uses X-rays to take multiple images of the body from different angles to recreate three-dimensional pictures of your internal organs on a computer. It is important that you choose a doctor and clinical team that you are comfortable with to perform your CT scan.

You may be asked to refrain from eating or drinking for a few hours before your scan. Be sure to inform your doctor prior to your scan if

You are pregnant or breastfeeding

You have any metal or electronic
devices implanted in your body (such
as a pacemaker or metal pins)

You are afraid of enclosed spaces
(claustrophobic)

You have previously had an allergic
reaction to contrast material

You are taking any vitamins, ayurvedic
medicines or homeopathic medicines

During a CT scan

You may be asked to change into a hospital gown and remove your jewellery, watch, body piercings or any other accessory that contains metal. You may also be asked to empty your bladder.

You may be given a special dye (called contrast material) which can help highlight the areas of your body that are being examined. The dye can be given to you by mouth (in a drink), by injection through a vein in your arm or by an enema in your rectum. You may need to wait for 30 minutes to an hour for your body to absorb the dye.

Next, a nurse or technician will take you to the room which contains the CT scanner. You will be asked to lie on a narrow, motorized table that will slide you into the machine. The nursing staff may use straps to keep you in position. You can ask for a pillow if you are feeling uncomfortable. You will be asked to remain still for the duration of the scan.

As the table moves you into the CT scanner, various detectors and X-ray tubes will rotate around you. Each rotation will produce several cross-section images of your body. You may hear some buzzing or whirring noises – try not to be alarmed and remember to stay still.

The technicians will be seated in a separate room, but they will be able to see and hear you. You may be asked to communicate with them via intercom. They may ask you to hold your breath at certain times to improve image quality.

The scan will usually take 20-30 minutes to complete.

After the scan, you may receive special instructions regarding the contrast material. For example, your technician or doctor may ask you to wait for a few minutes to ensure that you do not have an allergic reaction. You may also be told to drink plenty of fluids to help your kidneys to flush out the contrast material through your urine.

MRI Scan

What to expect

Magnetic resonance imaging (MRI) scan is a procedure in which an MRI scanner uses a high-powered magnet and a computer for comprehensive images of the internal organs and surrounding structures. MRI scans normally add supplementary information about cervical anomalies and may be recommended only in select cases. The scan is generally painless. It is important that you choose a doctor and clinical team that you are comfortable with to perform your MRI scan.

You may be asked to refrain from eating or drinking for a few hours before your scan. Be sure to inform your doctor prior to your scan if:

You are pregnant or breastfeeding

You have any metal or electronic
devices implanted in your body (such
as a pacemaker or metal pins)

You are afraid of enclosed spaces
(claustrophobic)

You have previously had an allergic
reaction to contrast material

You are taking any vitamins, ayurvedic
medicines or homeopathic medicines

During a MRI scan:

You may be asked to change into a hospital gown and remove your jewellery, watch, body piercings or any other accessory that contains metal. You may also be asked to empty your bladder.

You may be given a special dye (called contrast material) which can help highlight the areas of your body that are being examined. The dye is typically administered by injection through a vein in your arm. You may need to wait for 30 minutes to an hour for your body to absorb the dye.

Next, a nurse or technician will take you to the room which contains the MRI machine. You will be asked to lie on a narrow, motorized table that will slide you into the machine. The nursing staff may use straps to keep you in position. You can ask for a pillow if you are feeling uncomfortable. You will be asked to remain still for the duration of the scan.

As the table moves you into the MRI machine, the machine creates a strong magnetic field around you and radio waves are directed at your body. You may hear repetitive noises such as thumping or tapping – try not to be alarmed and remember to stay still. You can request earplugs or have music playing to help you block out the noise.

The technicians will be seated in a separate room, but they will be able to see and hear you. You may be asked to communicate with them via intercom.

The scan will usually take about 30 minutes to an hour to complete.

After the scan, you may receive special instructions regarding the contrast material. For example, your technician or doctor may ask you to wait for a few minutes to ensure that you do not have an allergic reaction. You may also be told to drink plenty of fluids to help your kidneys to flush out the contrast material through your urine.

PET Scan

What to expect

PET (Positron emission tomography) scan is a process that uses radioactive glucose to detect malignant tumour cells in the body. Malignant tumour cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. The scan is generally painless. It is important that you choose a doctor and clinical team that you are comfortable with to perform your PET scan. Some hospitals have a combined PET/CT scanner.

You may be asked to refrain from eating or drinking for a few hours before your scan. Be sure to inform your doctor prior to your scan if:

You are pregnant or breastfeeding

You have any metal or electronic
devices implanted in your body (such
as a pacemaker or metal pins)

You are afraid of enclosed spaces
(claustrophobic)

You have previously had an allergic
reaction to contrast material

You are taking any vitamins, ayurvedic
medicines or homeopathic medicines

During a PET scan:

You may be asked to change into a hospital gown and remove your jewellery, watch, body piercings or any other accessory that contains metal. You may also be asked to empty your bladder.

You may be given a special dye (called contrast material) which can help highlight the areas of your body that are being examined. The dye can be given to you by mouth (in a drink), by injection through a vein in your arm or by an enema in your rectum. You may need to wait for 30 minutes to an hour for your body to absorb the dye.

Next, a nurse or technician will take you to the room which contains the PET scanner. You will be asked to lie on a narrow, motorized table that will slide you into the scanner. The nursing staff may use straps to keep you in position. You can ask for a pillow if you are feeling uncomfortable. You will be asked to remain still for the duration of the scan.

As the table moves you into the PET scanner, the machine will begin to rotate around you. Each rotation will produce several cross-section images of your body. You may hear some buzzing or whirring noises – try not to be alarmed and remember to stay still.

The technicians will be seated in a separate room, but they will be able to see and hear you. You may be asked to communicate with them via intercom.

The scan will usually take about 30 minutes to an hour to complete.

After the scan, you may receive special instructions regarding the contrast material. For example, your technician or doctor may ask you to wait for a few minutes to ensure that you do not have an allergic reaction. You may also be told to drink plenty of fluids to help your kidneys to flush out the contrast material through your urine.

How cervical cancer is staged

The results of your diagnostic tests will help your doctor determine the size and position of the cancer, and whether it has spread. This is called staging. Knowing the stage and grade of your cancer will help your doctor plan the best course of treatment for you.

Typically, the number staging system is used for describing the stage of cervical cancer. Cervical cancer is divided into four number stages.

Stage 1 cervical cancer is when the tumour is not larger than 4cm and is found only in the cervix. Stage 1 cancers are further divided into stages 1A and 1B, depending on the size of the tumour and the deepest point of tumour invasion.

Stage 2 cervical cancer is when the tumour is 4cm or larger and has spread from the cervix to the vagina or tissue around the uterus. Stage 2 cancers are further divided into stages 2A and 2B, depending on the size of the tumour and how far the cancer has spread.

Stage 3 cervical cancer has spread from the cervix to the vagina, pelvic wall, kidneys or the lymph nodes. Stage 3 cancers are further divided into stages 3A, 3B and 3C, depending on the size of the tumour and how far the cancer has spread.

Stage 4 cervical cancer is also called metastatic cervical cancer. This is when the cancer has spread from the pelvic area to other parts of the body, such as the bladder, rectum, bones, the liver or lungs.

Treatment options for cervical cancer

Treatment for cervical cancer depends on several factors, like the type and stage of your cancer, or other health problems you may have. Surgery, chemotherapy, radiation, or a combination of all three may be used. Refer to this section to understand the types of cancer treatments and their effects. Read more

Your cancer journey

Everyone deals with a cancer diagnosis and treatment in a different way. Refer to this section to understand
various aspects of your cancer journey and the road to recovery. Read more

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