It’s important to diagnose cervical cancer early and accurately and find out if it has spread. This helps doctors choose the best treatment. At MD Anderson, our pathologists, diagnostic radiologists and specially trained technicians use the most modern and accurate equipment to diagnose cervical cancer and the stage of the disease, which increases the likelihood treatment will be successful.
Cervical cancer diagnostic tests
If symptoms or Pap test results suggest precancerous cells or cervical cancer, the patient’s doctor will conduct an examination and ask questions about her health; lifestyle habits; and family medical history.
One or more of the following tests may be used to find out if you have cervical cancer and if it has spread. These tests also may be used to find out if treatment is working.
Colposcopy: This test uses an instrument called a colposcope to look more closely at an area of abnormal tissue on the cervix, vagina or vulva. A colposcope is a microscope designed to examine the cervix. It looks like a pair of binoculars on a stand.
Biopsy: During a biopsy to look for cervical cancer, the doctor removes a small amount of tissue from the cervix to observe under a microscope. Types of cervical biopsies include:
- Punch biopsy: The tissue sample is removed from the cervix using biopsy forceps, an instrument used to grasp tissue firmly and remove it.
- Endocervical curettage (ECC): A tissue sample is scraped from an area just past the opening of the cervix using a curette (small, spoon-shaped instrument) or a thin, soft brush.
- LEEP (Loop electro-surgical excision procedure): This test uses a small wire that is heated with low-voltage, high-frequency radio waves to remove cells from the cervix.
- Cone biopsy: A cone-shaped sample of tissue is removed so the pathologist can see if abnormal cells are in the tissue beneath the surface of the cervix. A scalpel (small sharp knife) is used in an operating room with local or general anesthesia. The amount of tissue removed is larger than that removed with other types of biopsy. This type of biopsy can be done by one of the following methods:
- Cystoscopy or proctoscopy: If a woman is diagnosed with cervical cancer and her doctor thinks it may have spread, she may have a cytoscopy or proctoscopy or both. These tests use lighted tubes to view the inside of the bladder (cystoscopy) or the anus, rectum and lower colon (proctoscopy).
Imaging tests, which may include:
- CT or CAT (computed axial tomography) scans
- MRI (magnetic resonance imaging) scans
- PET (positron emission tomography) scans
- Chest X-ray
Lymph node dissection: Lymph nodes are removed to help find if cancer has spread.
Getting a Second Opinion at MD Anderson
The pathologists at MD Anderson are highly specialized in diagnosing and staging cervical cancers and welcome the opportunity to provide second opinions.
Some people have an elevated risk of developing cervical cancer. Review the cervical cancer screening guidelines to see if you need to be tested.
Behavioral and lifestyle changes can help prevent cervical cancer. Visit our prevention and screening section to learn how to manage your risk.
If you are diagnosed with cervical cancer, your doctor will determine the stage (or extent) of the disease. Staging is a way of classifying cancer by how much disease is in the body and where it has spread when it is diagnosed. This helps your doctor plan the best way to treat the cancer.
Once the staging classification is determined, it stays the same even if treatment works or the cancer spreads.
(source: National Cancer Institute)
Stage 0: Abnormal cells are found in the inner lining of the cervix. These abnormal cells may become cancer and spread to nearby normal tissue. Stage 0 also is called carcinoma in situ.
Stage I: The cancer has formed and is in the cervix only.
- Stage IA: A small amount of cancer that can only be seen with a microscope is in the tissues of the cervix
- Stage IA1: The cancer is not more than 3 millimeters deep.
- Stage IA2: The cancer is measured between 3 and 5 millimeters deep.
- Stage IB: Cancer has formed, measuring more than 5 millimeters deep and is limited to the cervix only.
- Stage IB1: Cancer measures more than 5 millimeters but less than 2 centimeters.
- Stage IB2: Cancer measures between 2 and 4 centimeters.
- Stage IB3: Cancer measures less than or equal to 4 centimeters.
Stage II: Cancer spreads beyond the cervix and uterus but has not spread to the lower third of the vagina or to the pelvic wall (the tissues that line the part of the body adjacent to the hips).
- Stage IIA: Cancer is limited to the upper two-thirds of the vagina but not to the parametrium (the tissue that surrounds the uterus).
- Stage IIA1: Cancer is limited to the upper two-thirds of the vagina and measures less than 4 centimeters in dimension.
- Stage IIA2: Cancer is limited to the upper two-thirds of the vagina and measures greater than or equal to 4 centimeters in dimension.
- Stage IIB: Cancer has spread to the parametrium (tissues around the uterus) but not up the pelvic wall (the tissues that line the part of the body between the hips).
Stage III: Cancer has spread to the lower third of the vagina and/or extends to the pelvic wall. It may also cause hydronephrosis (the swelling of a kidney due to buildup of urine) or non-functioning kidney, and may spread to pelvic and/or para-aortic lymph nodes (the lymph nodes in the abdomen below the rib cage and above pelvis, near the largest blood vessel in the body).
- Stage IIIA: Cancer has spread to the lower third of the vagina with no extension to the pelvic wall.
- Stage IIIB: Cancer has spread to the pelvic wall and/or caused hydronephrosis (swelling of a kidney due to buildup of urine) or a non-functioning kidney.
- Stage IIIC: Cancer has spread to the pelvic and/or para-aortic lymph nodes regardless of the size of the tumor.
- Stage IIIC1: Cancer has spread to the pelvic lymph nodes only.
- Stage IIIC2: Cancer has spread to the para-aortic lymph nodes.
Stage IV: Cancer has invaded the bladder or rectum in the pelvis or spread to distant organs.
- Stage IVA: Cancer has spread to nearby organs in the pelvis (rectum and bladder).
- Stage IVB: Cancer has spread to distant organs (such as the abdomen, liver, intestinal track or lungs).
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