Cervical Cancer diagnosis starts with a Pap test. If it is normal (formerly class I), it is repeated at the interval the doctor has determined to be appropriate for the woman. If the Pap test is atypical (former class II), the doctor likely will recommend to repeat the test in 3 or 6 months. There might have been an infection of the cervical canal or a vaginitis, which caused the cervical cells to look atypical, in which case the repeat test likely will be normal again.
However, if the atypical Pap test remains, or if the initial Pap test showed dysplasia, it is better to refer the woman to a gynecologist who is trained in colposcopy.
What is colposcopy?
It is a superb method to further evaluate an abnormal Pap smear. It involves a type of operating microscope (colposcope) with a roughly 15 power magnification. The patient is positioned in the same position as for a Pap test. With a very bright light and a green filter the colposcopist can identify any abnormal vascular patterns on the surface of the cervix. Any abnormal looking spot is biopsied, which is painless as the cervix has hardly any nerve supply and the biopsies are microscopically small bites. If the pathologist reports these biopsy samples as “dysplastic” or “malignant” cells, the gynecologist will have to perform a conization.
What is conization?
This is a procedure, which can be done on a day-care basis. The specialist removes a cone-shaped portion of cervical tissue in order to be able to send a block of tissue to the pathologist. This tissue sample includes the so-called “transformation zone”, which is the line where the lining of the cervical canal meets the outside surface lining. With the hormonal changes within the menstrual cycle over a lifetime this is the high risk area from which most cancers of the cervix arise. If there is cancer in this conical tissue sample, the pathologist can indicate exactly how deep the cancer went and whether or not any cancer was present “in the margins”. In other words: the specialist did not get all the cancer, if the margin was not free of cancer; but it would be an early cancer, if the margin was free of cancer.
Invasive cancer requires more than conization
There are situations where a cone biopsy should not be done: in the case of a cancer of the cervix that could be identified by colposcopy and where the biopsy confirmed that it is indeed invasive. In this case conization is not radical enough, as cancerous tissue would be left behind. After detailed staging appropriate cancer therapy is necessary!
Cervical Cancer Diagnosis (Colposcopy)
What other tests?
The physician needs to a number of other tests to assess the exact extent of the cervical cancer in a particular patient (see below). The name for this is “staging work-up”. Below I explain this in more detail.
For instance, a CT scan of the pelvis and possibly the region of the aorta should be done to rule out any metastases to pelvic or paraaortic lymph glands. A chest X-ray is done to rule out lung metastases. Cystoscopy and proctosigmoidoscopy check out the bladder and the rectum/sigmoid colon area for metastases. If there is evidence of ovarian involvement, an exploratory laparotomy may have to be undertaken.
Blood tests to complete work-up for cervical cancer
Blood tests involve liver function tests to rule out liver metastases, renal function tests to rule out kidney obstruction as well as general blood tests for tumor markers and bone marrow function. Occasionally special circumstances will require other tests in certain situations such as an MRI scan or a lymphangiogram to study the lymphatic flow from the legs into the paraaortic lymph glands.
References
1. Cancer: Principles &Practice of Oncology.4th edition. Edited by Vincent T. DeVita, Jr. et al. Lippincott, Philadelphia,PA, 1993. Chapter on gynecological tumors.
2. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T. DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia, PA, 1997. Chapter on gynecological tumors.
3. WG Quint et al. J Pathol 2001 May;194(1):51-58.
4. A Duenas-Gonzalez et al. Am J Clin Oncol 2001 Apr;24(2):201-203.
5. BD Kavanagh et al. Am J Clin Oncol 2001 Apr;24(2):113-119.
6. K Nakanishi et al. Skeletal Radiol 2001 Mar;30(3):132-137.
7. M Follen et al. Cancer 2001 May 1;91(9):1758-1776.
