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How is cervical cancer diagnosed?
You may have tests for cervical cancer because you have symptoms or because your cervical screening test results suggest that you have a higher risk of developing cervical cancer.
Some tests allow your doctor to see the tissue in your cervix and surrounding areas more clearly. Other tests tell the doctor about your general health and whether the cancer has spread. You probably won’t need to have all the tests described below.
Cervical screening is the process of looking for cancer or precancerous changes in women who don’t have any symptoms. The cervical screening test detects cancer-causing types of HPV in a sample of cells taken from the cervix.
The National Cervical Screening Program recommends that women aged 25–74 have a cervical screening test two years after their last Pap test, and then once every five years. Whether you identify as straight, lesbian, gay, bisexual, transgender or intersex, if you have a cervix you should have regular cervical screening tests.
During both the old Pap test and the new cervical screening test the doctor gently inserts an instrument called a speculum into the vagina to get a clear view of the cervix. The doctor uses a brush or spatula to remove some cells from the surface of the cervix. This can feel slightly uncomfortable, but it usually takes only a minute or two. The sample is placed into liquid in a small container and sent to a laboratory to check for HPV.
If HPV is found, a specialist doctor called a pathologist will do an additional test on the sample to check for cell abnormalities. This is called liquid-based cytology (LBC).
The results of the cervical screening test are used to predict your level of risk for significant cervical changes. If the results show:
- a higher risk – your GP will refer you to a specialist (gynaecologist) for colposcopy
- an intermediate risk – you will be monitored by having a follow-up test (usually for HPV) in 12 months and more frequent screening tests in the future
- a low risk – you will be due for your next cervical screening test in five years.
A small number of women are diagnosed with cervical cancer because of an abnormal cervical screening test. For more information about screening tests, call Cancer Council 13 11 20 or visit cervicalscreening.org.au.
If the cervical screening test results show that you have a higher risk of significant cervical changes, you will usually be referred for a colposcopy. A colposcopy lets your doctor look closely at the cervix to see where any abnormal or changed cells are and what they look like.
The colposcope is a magnifying instrument that has a light and looks like a pair of binoculars on a large stand. It is placed near your vulva but does not enter your body.
A colposcopy usually takes 10–15 minutes. You will be advised not to have sex or put anything in your vagina (e.g. tampons) for 24 hours before the procedure.
You will lie on your back in an examination chair with your knees up and apart. The doctor will use a speculum to spread the walls of your vagina apart, and then apply a vinegar-like liquid or 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 doctor sees any suspicious-looking areas, they will usually take a tissue sample (biopsy) from the surface of the cervix for examination. 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 doctor will send the tissue sample 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 experience cramping that feels similar to menstrual pain. Pain is usually short-lived and you can take mild pain medicines such as paracetamol or non-steroidal anti-inflammatory drugs. You may also have some light bleeding or other vaginal discharge for a few hours.
To allow the cervix to heal and to reduce the risk of infection, your doctor will probably advise you not to have sexual intercourse or use tampons for 2–3 days after a biopsy.
If any of the tests show precancerous cell changes, you may have one of the following treatments to 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 removing cervical tissue to treat precancerous changes of the cervix. The abnormal tissue is removed using a thin wire loop that is heated electrically. The doctor aims 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 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. This will usually ease in a few days, but you may notice some spotting for 3–4 weeks. If the bleeding lasts longer than 3–4 weeks, becomes heavy or smells bad, see your doctor. To allow your cervix to heal and to prevent infection, you should not have sexual intercourse or use tampons for 4–6 weeks after the procedure.
After a LLETZ or LEEP you can still become pregnant, however 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, when early-stage cancer is suspected, or for older women needing a larger excision. In some cases, it is also used to treat very small, early-stage cancers, particularly for young women who would like to have children in the future.
The 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. The tissue is examined to make sure that all the abnormal cells have been removed. Results are usually available within a week.
Side effects of a cone biopsy – You may have some light bleeding or cramping for a few days after the cone biopsy. 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 a bad smell, see your doctor. Some women notice a dark brown discharge for a few weeks, but this will ease.
To allow 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.
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 remove the abnormal cells or pieces of tissue for further study.
A laser beam is a strong, hot beam of light. The laser beam is pointed at the cervix through the vagina. The procedure is done under local anaesthetic. Laser surgery takes about 10–15 minutes, and you can go home as soon as the treatment is over.
Laser surgery works just as well as LLETZ 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. Most women are able to return to normal activity 2–3 days after having laser surgery, but will need to avoid sexual intercourse for 4–6 weeks.
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.
You may have a blood test to check your general health, and how well your kidneys and liver are working.
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.
Before having scans, tell the doctor if you have any allergies or have had a reaction to contrast during previous scans. You should also let them know if you have diabetes or kidney disease or are pregnant.
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.
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 build up 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.
During the scan, you will lie on a treatment table that slides into a large metal cylinder that is open at both ends. The noisy, narrow machine can make some people feel anxious or claustrophobic. If you think you may become distressed, mention it 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 30–90 minutes.
PET scan – Before a PET (positron emission tomography) scan, you will be injected with a glucose (sugar) solution containing some radioactive material. You will be asked to lie still for 30–60 minutes while the solution spreads throughout your body.
Cancer cells show up brighter on the scan because they absorb more of the glucose solution than normal cells do. It may take a few hours to prepare for a PET scan, but the scan itself usually takes about 30 minutes.
PET–CT scan – A PET scan combined with a CT scan is a specialised test available at many major metropolitan hospitals. It produces a three-dimensional colour image. The CT helps pinpoint the location of any abnormalities revealed by the PET scan.
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 and send the sample to a laboratory for examination.
Pelvic examination – The doctor will put a speculum into your vagina and spread the walls of the vagina apart so they can check your 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 thin tube with a lens and a light called a cystoscope will be inserted into your urethra (the tube that drains urine from the bladder to the outside of the body) to 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 experience.
This information is reviewed by
This information was last reviewed in September 2019 by the following expert content reviewers: A/Prof Penny Blomfield, Gynaecological Oncologist, Hobart Women’s Specialists, and Chair, Australian Society of Gynaecological Oncologists, TAS; Karina Campbell, Consumer; Carmen Heathcote, 13 11 20 Consultant, Cancer Council Queensland; Dr Pearly Khaw, Consultant Radiation Oncologist, Peter MacCallum Cancer Centre, VIC; A/Prof Jim Nicklin, Director, Gynaecological Oncology, Royal Brisbane and Women’s Hospital, and Associate Professor Gynaecologic Oncology, The University of Queensland; Prof Martin K Oehler, Director, Gynaecological Oncology, Royal Adelaide Hospital, SA; Dr Megan Smith, Program Manager – Cervix, Cancer Council NSW; Pauline Tanner, Cancer Nurse Coordinator – Gynaecology, WA Cancer & Palliative Care Network, WA; Tamara Wraith, Senior Clinician, Physiotherapy Department, The Royal Women’s Hospital, VIC.