Cervical cancer can be diagnosed by the doctor on the basis of major symptoms like abnormal vaginal bleeding or pain during sex in the patient but tests are always required to confirm pre-malignant and malignant condition.
If there is a diagnosis of invasive cancer, additional specific tests are required before planning treatment of the patient. Patient is also referred to oncologist for chemotherapy.
A) Diagnosis and testing
Medical history and physical exam
Personal and family medical history is taken from the patient to rule out any potential risk of cervical cancer. Information regarding risk factors and symptoms of cervical cancer is taken from the patient. A complete physical exam helps the doctor in reaching final diagnosis. Pelvic exam is done by the physician to find any possible signs of cervical cancer.
In pelvic examination, the doctor looks for abnormal changes in her cervix, uterus, vagina, ovaries, and other nearby organs. Initially, doctor observes woman’s vulva outside the body. Instruments like speculum can be used to keep vaginal walls open. Bimanual pelvic exam involves insertion of 2 fingers of one hand inside the patient’s vagina while the other hand presses on the lower part of abdomen to check any unusual changes in uterus and ovaries. It is normally done in an outpatient setting. A Pap test is often done at the same time. Pap test can be ordered if it is not done previously. An abnormal Pap test result requires further tests to rule out risk of cervical cancer.
The following tests may be used to evaluate patient for cervical cancer:
1. Pap test
During a Pap test, the doctor takes samples of cervical cells by scraping the mucus lining of cervix and vagina.
There are two types of pap tests:
- The liquid-based cytology test involves transference of a thin layer of cervical cells onto a glass slide. The sample is preserved so that it can be used for further tests if results are unsatisfactory. Blood and mucus should be removed from the sample before this test.
- Computer screening, often called AutoPap or FocalPoint, involves scanning of the sample from cervix. It detects any abnormal changes in cervical mucosa.
Results of pap tests are as follows:
- Normal – Healthy cervix showing no abnormal changes.
- Unsatisfactory – Sample was not satisfactory and test should be repeated.
- Benign changes – It refers to any inflammatory changes caused by infection in the pelvic region. Pelvic exam rules out any such cause.
- ASCUS (“Atypical Squamous Cells of Undetermined Significance”) – It denotes any abnormal changes in the cervix. Further tests are required to rule out cervical cancer.
- LSIL (Low Grade Squamous Intraepithelial Lesion) – It refers to the fact you are infected with HPV infection. Test should be repeated after 12 months in such case. Colposcopy can also be ordered to further evaluate the condition.
- HSIL (High Grade Intraepithelial Lesion) – It denotes abnormal changes in the cervix. Pre-malignant conditions like CIN 2 and CIN 3 are referred as HSIL. They have high probability of transforming into invasive cancer, if not treated.