How is cervical cancer diagnosed?

A colposcopy is a way of looking closely at the cervix and vagina to see if there are any abnormal or changed cells. It is done by a colposcopist, who is usually a gynaecologist or, in some clinics, a nurse practitioner.

A colposcopy takes about 10–15 minutes. You will usually be advised not to have sex or put anything in your vagina (e.g. tampons) for 24 hours before the procedure.

This procedure is done with an instrument called a colposcope, which is a microscope with a light. The colposcope is placed near your vulva but does not enter your body.

You will lie on your back in an examination chair with your knees up and apart. The colposcopist will use a speculum to spread the walls of your vagina apart, and then apply a vinegar-like liquid and iodine to your cervix and vagina. This makes it easier to see abnormal cells through the colposcope. You may feel a mild stinging or burning sensation, and you may have a brown discharge from the vagina afterwards.

If the colposcopist sees any suspicious-looking areas, they will usually take a tissue sample (biopsy) from the surface of the cervix. You may feel uncomfortable for a short time while the tissue sample is taken.

You will be able to go home once the colposcopy and biopsy are done. The tissue sample is sent to a laboratory, and a pathologist will examine the cells under a microscope to see if they are cancerous. The results are usually available in about a week.

Side effects of a colposcopy with biopsy – After the procedure, it is common to have cramping that feels similar to menstrual pain. This may last a short time and can be relieved with mild pain medicines such as paracetamol or non-steroidal anti-inflammatory drugs. You may also have some light bleeding or other vaginal discharge for up to a week.

To give the cervix time to heal and to reduce the risk of infection, your colposcopist will probably advise you not to have sexual intercourse or use tampons for up to a week after the procedure.

If any of the tests show precancerous cell changes, you may have one of the following procedures to remove the area of abnormal cells and prevent you developing cervical cancer.

Large loop excision of the transformation zone (LLETZ)

Also called loop electrosurgical excision procedure (LEEP), this is the most common way of treating precancerous changes of the cervix. The abnormal tissue is removed using a thin wire loop that is heated electrically. The aim is to remove all the abnormal cells from the surface of the cervix.

A LLETZ or LEEP is done under local anaesthetic in your doctor’s office or under local or general anaesthetic in hospital. It takes about 10–20 minutes. The tissue sample is sent to a laboratory for examination under a microscope. Results are usually available within a week.

Side effects of a LLETZ or LEEP – After a LLETZ or LEEP, you may have some vaginal bleeding and cramping. These side effects will usually ease in a few days, but you may notice some spotting for several weeks.

If the bleeding lasts longer than 3–4 weeks, becomes heavy or has an unpleasant smell, see your doctor. To give your cervix time to heal and to prevent infection, you should not have sexual intercourse or use tampons for 4–6 weeks after the procedure. You will also need to avoid swimming pools and spas.

After a LLETZ or LEEP you can still become pregnant, but you may have a slightly higher risk of having the baby prematurely. Talk to your doctor before the procedure if you are concerned.

This procedure is similar to a LLETZ. It is used when the abnormal cells are found in the cervical canal, for women who need a larger area removed or when early-stage cancer is suspected. In some cases, a cone biopsy is also used to treat very early-stage cancers, particularly for young women who would like to have children in the future.

A cone biopsy is usually done as day surgery in hospital under general anaesthetic. A surgical knife (scalpel) is used to remove a cone-shaped piece of tissue from the cervix. A pathologist examines the tissue to make sure all the abnormal cells have been removed. Results are usually available within a week.

Side effects of a cone biopsy – After a cone biopsy, you may have some light bleeding or cramping for a few days. Avoid doing any heavy lifting for a few weeks, as the bleeding could become heavier or start again. If the bleeding lasts longer than 3–4 weeks, becomes heavy or has an unpleasant smell, see your doctor. You may notice a dark brown discharge for a few weeks, but this will pass. To give your cervix time to heal and to prevent infection, you should not have sexual intercourse or use tampons for 4–6 weeks.

A cone biopsy may weaken the cervix. You can still become pregnant after a cone biopsy, but you may be at a higher risk of having a miscarriage or having the baby prematurely. If you would like to become pregnant in the future, talk to your doctor before the procedure.

This procedure uses a laser beam instead of a knife to vaporise or remove the abnormal cells.

A laser beam is a strong, hot beam of light. The laser beam is pointed at the cervix through the vagina. Laser surgery is done under either local or general anaesthetic. It takes about 10–15 minutes, and you can go home as soon as the treatment is over and you have recovered from the anaesthetic.

Laser surgery works just as well as LLETZ to remove precancerous cells and may be a better option if the precancerous cells extend from the cervix into the vagina or if the lesion on the cervix is very large.

Side effects of laser surgery – These are similar to those of LLETZ or LEEP. You are usually able to return to your usual activities 2–3 days after having laser surgery, but you should not have sexual intercourse or use tampons for 4–6 weeks. You will also need to avoid swimming pools and spas.

If any of the tests or procedures show that you have cervical cancer, you may need further tests to find out whether the cancer has spread to other parts of your body. This is called staging. You may have one or more of the tests described below.

Blood test

You may have a blood test to check your general health, and how well your kidneys and liver are working.

Imaging scans

Various imaging scans can create pictures of the inside of your body and provide different types of information. You may have one or more of the following imaging scans to find out if the cancer has spread to lymph nodes in the pelvis or abdomen, or to other organs in the body.

CT scan – A CT (computerised tomography) scan uses x-rays to take pictures of the inside of your body and then compiles them into a detailed, three-dimensional picture.

When you make the appointment for the scan, you will be told if there are any special instructions to follow. Before the scan, you may be given a drink or an injection of a dye (called contrast) into one of your veins. The contrast may make you feel hot all over for a few minutes. You may also be asked to insert a tampon into your vagina. The dye and the tampon make the pictures clearer and easier to read.

During the scan, you will need to lie still on a table that moves in and out of the CT scanner, which is large and round like a doughnut. The scan is painless and takes 5–10 minutes.

MRI scan – An MRI (magnetic resonance imaging) scan uses a powerful magnet and radio waves to create detailed cross-sectional pictures of the inside of your body. Let your medical team know if you have a pacemaker or any other metal implant, as some may affect how an MRI works.

Sometimes gel is placed in the vagina before the MRI scan to better show the cervix or vagina. During the scan, you will lie on a treatment table that slides into a large metal cylinder that is open at both ends.

The test is painless but the noisy, narrow machine can make some people feel anxious or claustrophobic. If you think you may become distressed, talk to your medical team before the scan. You may be given medicine to help you relax, and you will usually be offered headphones or earplugs. Most MRI scans take between 30 and 90 minutes.

PET–CT scan – A PET (positron emission tomography) scan combined with a CT scan is a specialised imaging test. It provides more detailed  information about the cancer than a CT scan on its own. Not all women need to have a PET–CT scan.

The imaging centre may give you instructions to follow before and after the scan. Before the scan, you will be injected with a glucose (sugar) solution containing a small amount of radioactive material. Cancer cells show up brighter on the scan because they take up more glucose than normal cells do. The radioactive material will leave your body within a few hours.

You will be asked to lie still for 30–60 minutes while the solution spreads through your body, then you will have the scan. Let your doctor know if you are claustrophobic, as you need to be in a confined space for the scan. It may take a few hours to prepare for a PET–CT scan, but the scan itself usually takes about 30 minutes.

Examination under anaesthetic

Another way to check whether the cancer has spread is for the doctor to examine your cervix, vagina, uterus, bladder and rectum. This is done in hospital under general anaesthetic.

If the doctor sees any abnormal areas of tissue during the procedure, they will take a biopsy. The area examined will depend on where the cancer may have spread to and may include:

Pelvic examination – The doctor will put a speculum into your vagina and spread the walls of the vagina apart so they can check the cervix and vagina for cancer.

Uterus – The cervix will be dilated (gently opened) and some of the cells in the lining of the uterus (endometrium) will be removed and sent to a laboratory for examination under a microscope. This is called a dilation and curettage (D&C).

Bladder – A tube with a camera and light on the end (a cystoscope) will be inserted into your urethra (a tube that drains urine from the bladder to the outside of the body). This lets the doctor examine your bladder.

Rectum – The doctor will use a gloved finger to feel for any abnormal growths inside your rectum. To examine your rectum more closely, the doctor may insert an instrument called a sigmoidoscope, which is a tube with an attached camera.

You will most likely be able to go home from hospital on the same day after one of these examinations under anaesthetic. You may have some light bleeding and cramping for a few days afterwards. Your doctor will talk to you about the side effects you may have.