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Diagnosis

Investigation

Women who are suspected to have cervical cancer, either after an abnormal Pap smear or as a result of symptoms related to cervical cancer (or for any other reason) will undergo further tests to confirm a diagnosis of cervical cancer.

Colposcopy

Most women with suspected cervical cancer will be sent for a colposcopy. For this examination, the specialist uses a colposcope, which is like a large microscope. The colposcope allows the specialist to have a magnified view of the cervix to check the extent and nature of any abnormality.

During the colposcopy examination, a small sample of tissue (a biopsy) may be taken from any abnormal looking areas of the cervix.

Biopsy

A biopsy is when your doctor or specialist removes some cervical tissue and sends it to the laboratory for examination under a microscope. When the tissue is removed, you may feel uncomfortable for a brief period of time.

Biopsies are usually performed in the examination room or in a clinic. The results should be back from the laboratory within about one week.

After a biopsy, you may experience some pain, similar to menstrual cramping. You can request medication to relieve the pain. You may also have some bleeding or other vaginal discharge, but these side effects will gradually disappear.

To allow the cervix to heal after a biopsy and to reduce the chance of infection, you should not have sexual intercourse or use tampons for at least a few days.

Further tests

If the biopsy shows you have cervical cancer, a number of other tests may be carried out. The tests will determine the extent of the cancer in your cervix and whether it has spread (metastasised) to other parts of the body. This is called staging. The results will help you and your doctor decide on the best treatment for you.

You may have one or more of the following tests:

Blood tests

You may have blood tests to assess your general health and to help with making decisions about your treatment.

Chest x-ray

An x-ray of the chest may be taken to check the lungs for signs of cancer that has spread.

CT scan

A computerised tomography (CT) scan is a type of x-ray procedure. It uses x-ray beams to take pictures of the inside of your body. This painless test will help your doctor assess if the cancer has spread to the lymph nodes or to other organs.

You may be asked to drink a special liquid (called contrast fluid) or have a tampon inserted into your vagina before the scan. These will help to give a clearer picture.

Sometimes a special liquid is also put into your rectum before the scan. This may make you feel hot all over for a few minutes.

A CT scan takes about 30 to 40 minutes. You will lie flat on a table while the CT scanner, which is large and round like a doughnut, rotates around you and takes a series of pictures.

After the scan, you can usually go home.

People who are allergic to iodine may also be allergic to the dye used in a CT or MRI scan. If you think you may have such an allergy, tell your doctor before the scan.

MRI scan

A magnetic resonance imaging (MRI) scan uses a powerful magnet linked to a computer to take detailed pictures of areas inside the body. The pictures are taken while you lie on a table that slides into a metal cylinder. An MRI scan is painless but some women find that lying in the cylinder is noisy and claustrophobic. You can sometimes request someone in your room for company. If you feel uncomfortable, let your doctor or nurse know. They can give you medication to ease this feeling.

The scan takes less than an hour, and most people are able to go home as soon as it is over.

PET scan

You might have a positron emission tomography (PET) scan.

Before the scan, you will be injected with glucose solution containing a small amount of radioactive material which takes 30 to 50 minutes to spread throughout your body. Cancerous cells will have an increased uptake of the glucose solution, which the PET scan will identify.

The scan takes about one hour.

Examination under an anaesthetic

You will be given a general anaesthetic so your vagina, cervix, bladder and rectum can be carefully examined. The doctor will insert a narrow instrument called a cystoscope into your urethra to examine your bladder. During this examination, a biopsy will be taken if necessary.

You may also have some of the cells in your uterus removed for examination. The process of removing the lining of the uterus (endometrium) is called a dilation and curettage (D&C). After a D&C, bleeding is common for a few days.