If you have symptoms or Pap test results that suggest precancerous cells or cancer of the cervix, your doctor will suggest other procedures to make a diagnosis. The first step is usually colposcopy, in which the doctor examines the cells of the cervix more closely. Another common test to more closely examine the cells is a biopsy, in which a sample of cervical cells is taken for examination.
If the biopsy indicates cervical cancer, you will be referred to a gynecologic oncologist, a doctor who specializes in treating cervical cancer. The specialist may suggest other tests to see if the cancer has spread beyond the cervix.
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Colposcopy is a diagnostic test used to evaluate an area of abnormal tissue on the cervix, vagina, or vulva using an instrument called a colposcope. A colposcope looks like a pair of binoculars on a stand. It magnifies tissue so a healthcare practitioner can see abnormalities that cannot be seen with the naked eye. The healthcare practitioner will insert a speculum to open the vagina and make the cervix visible, swab the cervix and vagina with a vinegar solution that makes abnormal tissue easier to see, position the colposcope between your legs, and look through it to examine the cervix. No part of the instrument will touch you, and you will not feel any pain. A colposcopy is usually done in the doctor's office or clinic.
You should not douche or use tampons or vaginal medications for 24 hours before the exam. If biopsies are taken during the colposcopy, you may experience light to medium bleeding for two to three days after the procedure. The bleeding should not be heavier than a menstrual flow. To allow the biopsy areas to heal, you should not have sexual intercourse, douche, or use tampons for two to three days.
In a biopsy, your doctor removes a small amount of tissue for examination under a microscope to look for precancerous cells or cancer cells. Most women have the biopsy in the doctor's office, and no anesthesia is needed. To do the biopsy, the doctor will insert a speculum to hold the vagina open and take a very small sample. After the sample is taken, it will be sent to a laboratory where a pathologist, a doctor who identifies diseases by studying cells and tissues, checks the tissue using a microscope. You may experience some bleeding and discharge after the exam and discomfort similar to menstrual cramps. Ibuprofen can be taken to relieve these symptoms. After a biopsy, you should not have sex, douche, or use tampons for 24 hours, or longer for biopsies that require local or general anesthesia.
Different types of cervical biopsies include:
Punch biopsy: The tissue sample is removed from the cervix using biopsy forceps, an instrument used to grasp tissue firmly and then remove it. This procedure is usually performed in your gynecologist's office and does not require anesthesia. You will feel a sharp pinch during the procedure. You may experience slight bleeding after the procedure.
Endocervical curettage (ECC): A tissue sample is scraped from an area just past the opening of the cervix using a curette (small, spoon-shaped instrument) or a thin, soft brush. This can be done in your doctor's office and does not require anesthesia. You will have some cramping and bleeding after the procedure.
LEEP (Loop Electro-Surgical Excision Procedure): The LEEP is performed using a small heated wire to remove tissue and precancerous cells from the cervix. This procedure can be done in your doctor's office and requires local anesthesia. You may have some cramping during and after the procedure. You may have moderate to heavy vaginal discharge that lasts for about three weeks.
Cone biopsy (also called LEEP cone or cold knife cone biopsy): A cone-shaped sample of tissue is removed from the cervix so that the pathologist can see if abnormal cells are in the tissue beneath the surface of the cervix. This specimen is much bigger than the biopsy done in the office without anesthesia. A sample of tissue can be removed for a cone biopsy using a LEEP cone procedure, which can be done in the doctor's office under local anesthesia, or a knife cone procedure, done in an operating room under local or general anesthesia. You may have some vaginal bleeding for about a week and some spotting for about three weeks after the procedure.
Pelvic examination: A pelvic examination is part of every gynecologic visit and should be done yearly. A pelvic exam includes a rectal exam. When a cancer diagnosis is made, the doctor examines the pelvic area to see if the cancer has spread to nearby organs, such as the uterus, vagina, bladder, and rectum.
If advanced cancer is diagnosed and your doctor suspects the cancer may have spread beyond the cervix, a cytoscopy or proctoscopy may be done using a lighted tube to view the inside of the bladder (cystoscopy) or the anus, rectum, and lower colon (proctoscopy). The procedure can be performed as an outpatient using minimal sedation or under general anesthesia.
To learn more about the extent of disease and suggest a course of treatment, the doctor may order some of the following imaging tests:
Chest X-ray: This is a picture of the chest that shows your heart, cervicals, airway, blood vessels, and lymph nodes. A chest X-ray can often show whether cancer has spread to the cervicals.
Computed tomography (CT) scan: This diagnostic test uses an X-ray machine and a computer to create detailed pictures of the body, including 3-D images. It is used to detect disease outside the cervix or abnormal organ structure. CT scans also can be used to guide a needle into a mass if a biopsy is needed. As part of a CT scan, you may be asked to drink oral contrast or have an IV (intravenous) line for injection of a contrast dye. Contrast dye makes your organs more visible on the X-ray film.
Magnetic resonance imaging (MRI): This diagnostic test uses magnetic fields and radio waves to create computerized pictures of the pelvis and abdomen. You may have to be placed in a tube, which can feel confining to people who have a fear of enclosed spaces. A contrast dye might be used. The MRI is noisy while it is operating, so patients are usually given earplugs. The doctor can view these pictures on film to see whether cancer has spread. This test may be done during pregnancy if necessary.
Positron Emission Tomography (PET) Scan: This diagnostic test uses a radioactive chemical, called a tracer, to create 3-D images of the body. A small dose of the radioactive tracer is injected into a vein in the arm. The tracer travels through the body, and the organs and tissues absorb it. The PET scanner, a tube-like machine, records the energy given off from the tracer in the body to create the 3-D images. In combination with CT scans, a PET scan determines the size and activity of abnormal tissue growth.
Last reviewed on 10/13/09
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