Cervical cancer - Diagnosing cervical cancer

If cervical cancer is suspected, you will be referred to a gynaecologist (a specialist in treating conditions of the female reproductive system).

Referral will be recommended if the results of your cervical screening test suggest that there are abnormalities in the cells of your cervix. However, in most cases the abnormalities do not mean that you have cervical cancer.

You may also be referred to a gynaecologist if you have abnormal vaginal bleeding or your GP noticed a growth inside your cervix during an examination.

The sexually transmitted infection (STI) chlamydia is one of the most common reasons why women experience unusual vaginal bleeding. Your GP may recommend that you are tested for it first before being referred. Testing for chlamydia involves taking a small tissue sample from your cervix or carrying out a urine test.

Colposcopy

If you have had an abnormal cervical screening test result, or your symptoms suggest that you may have cervical cancer, your gynaecologist will usually carry out a colposcopy. A colposcopy is an examination to look for any abnormalities in your cervix.

During a colposcopy, a small microscope with a light source at the end (colposcope) is used. As well as examining your cervix, your gynaecologist may remove a small tissue sample (biopsy) so that it can be checked under a microscope for cancerous cells.

Cone biopsy

In some cases, a minor operation called a cone biopsy may also be carried out. This operation is carried out in hospital, usually under a local anaesthetic.

During a cone biopsy, a small, cone-shaped section of your cervix will be removed so that it can be examined under a microscope for cancerous cells. You may experience vaginal bleeding for up to four weeks after the procedure. You may also have period-like pains.

Further testing

If the results of the biopsy suggest you have cervical cancer and there's a risk that the cancer may have spread, you'll probably need to have some further tests to assess how widespread the cancer is. These tests may include:

• a pelvic examination carried out under general anaesthetic – your womb, vagina, rectum and bladder will be checked for cancer
• blood tests – these can be used to help assess the state of your liver, kidneys and bone marrow
• computer tomography (CT) scan – scans are taken of the inside of your body and a computer is used to assemble them into a detailed three-dimensional image; this is useful for showing up cancerous tumours and checking whether the cancerous cells have spread
• magnetic resonance imaging (MRI) scan – this type of scan uses strong magnetic fields and radio waves to produce detailed pictures of the inside of your body; it can also be used to check whether cancer has spread
• chest X-ray – this will indicate whether cancer has spread to your lungs
• positive emission tomography (PET) scan – a specialised scan where a mildly radioactive substance is injected into your veins so the cancerous tissue shows up more clearly; it is often combined with a CT scan and is used to see if the cancer has spread or to check how well a person is responding to treatment

Staging

After all of the tests have been completed and your test results are known, it should be possible to tell you what stage cancer you have. Staging is a measurement of how far the cancer has spread. The higher the stage, the further the cancer has spread. The staging for cervical cancer is as follows:

• stage 0 (pre-cancer) – there are no cancerous cells in the cervix, but there are biological changes that could trigger the onset of cancer in the future; this is called cervical intraepithelial neoplasia (CIN) or carcinoma in situ (CIS)
• stage 1 – the cancer is still contained inside the cervix
• stage 2 – the cancer has spread outside the cervix into the surrounding tissue, but has not reached the tissues lining the pelvis (pelvic wall) or the lower part of the vagina
• stage 3 – the cancer has spread into the lower section of the vagina and/or into the pelvic wall
• stage 4 – the cancer has spread into the bowel, bladder or other organs, such as the lungs