Cervical Cancer

Diagnosis

There are several different tests that can be used to determine a cervical cancer. It helps to understand exactly what tests  involved in a particular procedure. Cancer of the cervix is best treated by a Gynaecological Oncologist.

Pre-cancerous changes in the cervix can be detected in a screening test known as a pap smear test.  If the Pap test suggests a problem that a low grade CIN is found, Pap smear is repeated four to six months and the patient is tested for HPV infection. If CIN is high grade, Colposcopy and biopsy may be suggested. 

In  Colposcopy an instrument called a colposcope, which is like a microscope, is used to take a close, detailed look at the cervix and vagina.  This procedure is normally carried out after an abnormal cervical smear test and allows a magnified view of the surface of the cervix. A doctor views the cell type, pattern of blood vessels and white patches on the cervix to help determine precancerous or cancerous chances. This technique can identify an area of abnormal cells, and a sample can then be taken for investigation. The results of a coloscopy help determine further treatment, such as a cone biopsy, or it may show cervical eversion as the cause of the abnormal cells. The coloscopy procedure takes 15 to 20 minutes and is painless. 

When abnormal cells is noticed during a colposcopy, then it is necessary to have a biopsy taken at the same time. In biopsy, a small amount of cervical tissues are removed for microscopic examination. There are a few different ways to do a biopsy. 

Cervical biopsy or punch biopsy is a test in which a portion of tissue samples are taken  from the cervix for further examination and to confirm if cancer is present. 

Some patients may need to have a further test called a Cone biopsy (cold cone biopsy or cold knife cone biopsy) to assist with diagnosis. In a cone biopsy a cone-shaped sample of cervical tissue for investigation and examination under a  microscope. Cone biopsy is carried out if one or more cervical smear tests indicate the presence of precancerous or cancerous cells in the cervix. This tissue is removed from the area between the ectocervix and the endocervix. It is done if a colposcopy has not isolated the abnormal cells. This can be done an anaesthetic. Sometimes a larger cone-shaped biopsy specimen may have to be taken. This procedure is called conization and for this the patient may need to be admitted to the hospital. Conization helps to assess how much tissue is diseased.

Loop electro -surgical excision procedure (LEEP)  is another method to do a biopsy.  This is a procedure that uses an electrical wire to slice off a thin, round piece of tissue for laboratory analysis which takes about 10 minutes. Mild pain may occur during the procedure  or afterwards. Side effects may be mild or moderate bleeding. 

In Endocervical curettage(ECC) a small spoon shaped instrument called a curette to scrape tissue from inside the cervical opening and examined for cancer cells.  This procedure is often performed during coloscopy. 

If these diagnosis found abnormal cells (dysplasia),  further tests may not be needed. But it may need treatment to remove these abnormal cells from the cervix. If  microinvasive or invasive cervical cancer, the patient may need further tests which may include some or all of the following.

CT scan
A CT (computerised tomography) scan  involves taking special X-rays at different angles to build up a 2- and 3-dimensional image of the body. A computer puts the scans together and creates detailed images of the body's organs in cross-section.

IVP
An IVP (intravenous pyelogram) is a urinary system special X-ray of your kidneys, bladder and ureters (the tubes that connect the kidneys to the bladder). This procedure may be used to identify urinary tract abnormalities caused by cancer that may have spread from the cervix.

Chest X-Ray
This imaging procedure shows whether cancer has spread from the cervix to the lungs. This is done when the cancer is far advanced. 

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