How does my doctor know I have cervical cancer?

If you’re having symptoms that are like those of cervical cancer, your doctor will want to know why. Your doctor will ask some questions regarding the following:

• Medical history
• Smoking history
• Family history of cancer
• How old you were when you first had sexual intercourse
• If you have had unprotected sex
• Other risk factors such as a history of genital warts or human papillomas virus (HPV) infection

And to learn more about your symptoms, your doctor will do a pelvic exam and tests.  Many women don’t have symptoms of cervical cancer. Sometimes your doctor may first see signs of cancer during a pelvic exam or a Pap test.

What A Doctor Learns from a Pelvic Exam

Your doctor or healthcare provider does a pelvic exam in the office. This exam is recommended as a regular screening for women. For it, you’ll remove your clothes from the waist down and put on a medical gown. You lie on your back on an exam table and bend your knees. You place your feet in supports called stirrups at the end of the table. This position allows the doctor to look at or feel your uterus, vagina, ovaries, fallopian tubes, bladder, and rectum. The doctor places a plastic or metal tool called a speculum inside your vagina to widen it. This lets the doctor see the upper portion of your vagina and your cervix. After removing the speculum, the doctor inserts 2 or 3 gloved fingers into your vagina and uses his or her other hand to press on your abdomen. This is to feel for lumps or anything unusual.

You may also have a Pap test and human papillomavirus (HPV) test during a pelvic exam.

Some cervical cancers may be found during a pelvic exam. While your doctor cannot see precancerous changes such as dysplasia, he or she can see some invasive cancers during an exam. If the doctor or nurse notices something suspicious during the pelvic exam, additional tests can help determine whether you have cervical cancer.
What Your Doctor Learns from a Pap Test

A Pap test is the standard way to see if there are any cell changes that cause concern. You should see your doctor once a year for a regular screening Pap test if you are sexually active or over the age of 18. This test can help find cervical cancer or problems before they become cancer. The Pap test is simple and relatively painless. You can have it right in the doctor’s office. You should not have this test done during your period. The best time to have a Pap test is 10 to 20 days after the first day of your last period.

A Pap test may feel uncomfortable, but it should not hurt, and it takes just seconds. The doctor uses a tool called a speculum to widen your vagina and examine the upper part of your vagina and cervix, which is the area that connects your vagina to your uterus. The doctor then uses a small, soft brush to collect cells from the cervix and vagina. A specialized doctor called a pathologist looks at the cells under a microscope to check for cancer.

There are 2 types of Pap tests. The difference between them has to do with how the cells are checked after they are taken from your cervix. There is not a difference in how the cells are removed from you.

• With the regular method, the cell sample gets put on a slide and checked in a lab.
• With the newer liquid-based test, the doctor mixes a special liquid with the cells. This helps to preserve the cells for testing so that they can be seen and checked more clearly in the lab.

Studies show that the newer test is more successful in finding precancerous cells. The newer method is also usually more expensive.

You should avoid these things before your Pap test.

• Do not douche for at least 2 days (48 hours).
• Do not have sex for 2 days (48 hours).
• Do not use a tampon for 2 days (48 hours).
• Do not use any kind of vaginal products or medicines for 2 days (48 hours).

Ask when you can expect results and how you will receive them. For instance, will you receive results by telephone or in the mail? Knowing how long you will have to wait for results may help you feel less anxious.

Why Your Doctor Does an HPV Test

If your Pap test shows that abnormal cells may be present, your doctor may do a human papillomavirus (HPV) test. This test looks at the abnormal cells to see if HPV is present. Some types of HPV increase the risk of cervical cancer. The Food and Drug Administration (FDA) has approved the use of the HPV test along with the Pap test for women 30 years of age and older, the age group most likely to develop cervical cancer. This simply means that rather than doing the HPV as a follow-up test, your provider may do the Pap test and the HPV test at the same time. Some doctors now do an HPV test even when a Pap test is normal.

The preparation for the HPV test is the same as for a Pap test. Avoid sex, douching, tampon use, or any kind of vaginal products or medicines for 2 days before the test.

How Your Doctor Uses a Colposcopy

If your doctor finds something suspicious during the pelvic exam or Pap test, he or she may decide to do a colposcopy. This test helps pinpoint abnormal areas in the cervix. This procedure can be done in a doctor’s office. You lie in the same position as for a pelvic exam, on your back with your knees up and feet in stirrups. The doctor inserts a tool called a speculum to widen your vagina. The doctor or nurse puts a vinegar-like solution (3% to 5% acetic acid) on your cervix. This helps highlight abnormal areas. Next, the doctor places a special microscope called a colposcope at the opening of your vagina to magnify the surface of the cervix up to 40 times its normal size. You may have a biopsy during a colposcopy. This involves removing tissue to be examined under a microscope. It may pinch some.  Depending on the results of these tests, your doctor may need to do a biopsy.

Tests That Help Evaluate Cervical Cancer

Your doctor took a biopsy from your cervix to know that you have cancer.  Your doctor may request more tests to learn more about your type of cancer and its specific location to help decide on the treatment that is likely to be most effective for you.

Your doctor will probably do imaging tests. These tests use machines that allow him or her to see inside your body and find the cancer. Most women need more than one test to find out their stage of cervical cancer. The tests will also help determine the best treatment for you. You’ll probably have a few weeks to make decisions about your treatment.

Here are some of the tests that may be used for cervical cancer. Your doctor will likely only do the first 3 if you have a large tumor.

If you have a large tumor, your doctor may need to take a closer look at your cervix and check other areas, such as your bladder and rectum, to see if the cancer has spread. To do this, your doctor will put you to sleep with a general anesthesia. Then he or she will do one or both of these tests.

• Proctoscopy - To see if the cancer has spread to the rectum and the bottom part of the large intestine, the doctor uses a special instrument called a sigmoidoscope. For this test, you undress from the waist down and put on a hospital gown. You lie on your left side on the exam table. You pull your knees up toward your chest. The doctor gently inserts the sigmoidoscope through your rectum and into your large intestine. Air blows through the scope to allow for better viewing. The air may cause cramps. You may feel like you need to take a bowel movement. The doctor can look for abnormal areas and take biopsies during this procedure. After the test, you will expel the air by passing gas.
• Cystoscopy - This test lets the doctor see if the cancer has spread to your bladder. For it, the doctor looks at the inside of your bladder with a special instrument called a cystoscope. You lie on your back with your knees up and slightly apart. The doctor or nurse cleans your urethra and applies some numbing medication. Or you have general anesthesia so you fall to sleep and don’t feel anything. The doctor inserts the cystoscope through your urethra and up into your bladder. Water or saline solution flows through the scope into your bladder. This stretches the bladder wall, giving the doctor a better view. You may have some discomfort or feel an urge to urinate. If needed, the doctor can take a tissue sample to check for cancer. The whole test takes between 5 and 20 minutes. You will need a ride home after the test. You may feel a burning sensation when you urinate for a few days after the test.
• Chest X-Ray - Doctors use this test to find out if the cancer has spread to your lungs. Unless the cancer is very advanced, it is not likely that the cancer has spread here. For the test, you stand in front of an X-ray scanner and hold your breath as the technician takes the picture. The test does not hurt, but the X-ray plate may feel cold against your skin.

Computed Tomography (CT) Scan

The doctor may order a CT scan to see if the cancer has spread to lymph nodes or to other internal organs such as your liver or lungs. Unfortunately, CT scans have not been helpful in finding smaller amounts of cancer in the pelvic lymph nodes. A CT scan uses X-rays to take pictures of your body from many angles. These special X-rays are much more sensitive than a typical X-ray. To have the test, you lie still on a table as it gradually slides through the center of the CT scanner. Then the scanner directs a continuous beam of X-rays at your pelvis. A computer uses the data from the X-rays to create many pictures of your pelvis, which can be used together to create a three-dimensional picture. A CT scan is painless and noninvasive. You may be asked to hold your breath one or more times during the scan. In some cases, you may be asked to drink a contrast dye 4 to 6 hours before the scan. And you may be asked not to eat anything in the time between drinking the contrast dye and the scan. The contrast dye will gradually pass through your system and exit through your bowel movements.

Magnetic Resonance Imaging (MRI)

MRIs are used to find if cancer has spread. This is another method of staging cervical cancer. MRIs use radio waves and magnets to create images of your body. For this test, you lie still on a table as it passes through a tubelike scanner. The scanner directs a continuous beam of radiofrequency radiation at the area being examined. A computer uses the data from the radio waves to create a three-dimensional picture of the inside of your body. You may need more than one set of images. Each one may take 2 to 15 minutes, so the whole scan may take an hour or more. This test is painless and noninvasive. Ask for earplugs if they aren’t offered since there is a loud thumping noise during the scan. If you’re claustrophobic, you may receive a sedative before having this test.
Intravenous Pyelogram (IVP)

This test allows your doctor to see if cancer has spread to the urinary tract. An IVP is an X-ray of your kidneys, bladder, and uterus, which are the tubes that carry urine from the kidneys down to the bladder. You will need to urinate before the exam. For this test, you lie flat on an exam table. After the nurse or doctor injects dye into a vein, a series of X-rays are taken at different intervals. You must stay still during the test. The test can take up to an hour. You may not need IVP if you’ve had a CT scan.

Positron-Emission Tomography (PET) Scan

This test shows whether the cancer has spread. The first step is for a doctor or nurse to inject a small amount of radioactive sugar into your vein. After about an hour, you lie down on an X-ray table that passes through a scanner. The scanner creates pictures that show where the sugar has collected in your body. Cancer cells use more sugar than normal cells. These imaging tests can help stage the cancer.
How Your Doctor Uses Biopsies to Diagnose Cervical Cancer

If your Pap test results show potential problems, or if your doctor feels something during a pelvic exam, you may need a biopsy. For it, your doctor removes tissue from your cervix. Then a pathologist looks at it under a microscope to check for cancer cells. Every suspected cervical abnormality should be biopsied, even if a doctor cannot see it.

These are the different types of biopsies for diagnosing cervical precancers and cancer.

• Colposcopic biopsy. To take this biopsy, the doctor uses a special microscope called a colposcope. The doctor places this at the opening of your vagina. It magnifies the cervix up to 40 times. Then, the doctor removes a small amount of tissue from the abnormal area on your cervix. A colposcopy can’t see cells high up in the cervix, so the doctor usually does an endocervical curettage (ECC) at the same time.
• Endocervical curettage (ECC). With this biopsy, the doctor scrapes tissue from the area between the outer part of the cervix and the inner part of the uterus. A pathologist looks at the removed cells to check for cancer.
• Conization. This test is also called a cone biopsy. The doctor does it to look at cells that are deeper in the cervix. The doctor uses a knife or electricity to remove a cone-shaped sample of tissue. Then a pathologist looks at the tissue to see if abnormal cells exist. If the doctor uses a knife, you’ll have the biopsy done in the hospital, while you’re sedated or asleep from general anesthesia. If your doctor uses a wire and electricity, it’s called a loop excision (LEEP). You may have this kind of biopsy in the doctor’s office. First, you’ll have medicine put into the cervix to numb it.
• Endometrial biopsy (EMB). Sometimes, a doctor cannot determine whether abnormal cells exist in the cervix or in the internal lining of the uterus, called the endometrium. If the doctor believes the abnormal cells might be coming from the endometrium, he or she may perform an EMB. For it, a doctor scrapes cells from the lining of the uterus until he or she finds out where the problem exists. This test can be done at the doctor’s office or in the hospital. No anesthesia is needed.

Some women may experience vaginal bleeding or cramps after these tests. This usually does not last long.

If the biopsy shows you have cancer, your doctor may order more tests, such as a computed tomography (CT scan). The results of all the tests determine the stage, which is the degree of spread, of the cancer. With this knowledge, your healthcare team designs the best treatment for you. Find out how your doctor plans on letting you know about your test results. And let your doctor know if there is a way you would like to be told about the results.