Booklet: What You Need to Know about Cervical Cancer

Diagnosis

The pelvic exam and Pap test allow the doctor to detect abnormal changes in the cervix. If these exams show that an infection is present, the doctor treats the infection and then repeats the Pap test at a later time. If the exam or Pap test suggests something other than an infection, the doctor may repeat the Pap test and do other tests to find out what the problem is.

Colposcopy is a widely used method to check the cervix for abnormal areas. The doctor applies a vinegar-like solution to the cervix and then uses an instrument much like a microscope (called a colposcope) to look closely at the cervix. The doctor may then coat the cervix with an iodine solution (a procedure called the Schiller test). Healthy cells turn brown; abnormal cells turn white or yellow. These procedures may be done in the doctor's office.

The doctor may remove a small amount of cervical tissue for examination by a pathologist. This procedure is called a biopsy. In one type of biopsy, the doctor uses an instrument to pinch off small pieces of cervical tissue. Another method used to do a biopsy is called loop electrosurgical excision procedure (LEEP). In this procedure, the doctor uses an electric wire loop to slice off a thin, round piece of tissue. These types of biopsies may be done in the doctor's office using local anesthesia.

The doctor also may want to check inside the opening of the cervix, an area that cannot be seen during colposcopy. In a procedure called endocervical curettage (ECC), the doctor uses a curette (a small, spoon-shaped instrument) to scrape tissue from inside the cervical opening.

These procedures for removing tissue may cause some bleeding or other discharge. However, healing usually occurs quickly. Women also often experience some pain similar to menstrual cramping, which can be relieved with medicine.

These tests may not show for sure whether the abnormal cells are present only on the surface of the cervix. In that case, the doctor will then remove a larger, cone-shaped sample of tissue. This procedure, called conization or cone biopsy, allows the pathologist to see whether the abnormal cells have invaded tissue beneath the surface of the cervix. Conization also may be used as treatment for a precancerous lesion if the entire abnormal area can be removed. This procedure requires either local or general anesthesia and may be done in the doctor's office or in the hospital.

In a few cases, it may not be clear whether an abnormal Pap test or a woman's symptoms are caused by problems in the cervix or in the endometrium (the lining of the uterus). In this situation, the doctor may do dilation and curettage (D and C). The doctor stretches the cervical opening and uses a curette to scrape tissue from the lining of the uterus as well as from the cervical canal. Like conization, this procedure requires local or general anesthesia and may be done in the doctor's office or in the hospital.

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