How cervical cancer is diagnosed

Usually women begin by seeing their family doctor (GP), either when they notice symptoms| , or if a cervical screening| test has found abnormal cervical changes. Your GP will examine you and refer you to hospital for any necessary tests and for specialist gynaecological advice and treatment.

The tests

Most women will have a test called a colposcopy . In this test a nurse or doctor uses a small microscope with a light (a colposcope) to examine your cervix. If your doctor cannot see area clearly enough, you may have another test: a large loop excision of the transformation zone (LLETZ) or a cone biopsy . These are minor operations that allow doctors to remove a section of tissue from the cervix. The tissue is then sent to a laboratory to be checked under a microscope.  

The tests will show whether you have cancer, and give other important information such as the stage| and type| of cancer. This information, as well as the physical examination and the results of further tests| your doctor may recommend, will help your doctors to know which is the best type of treatment for you.

How the tests are carried out

Colposcopy

This is usually done in a hospital outpatient clinic. Some hospitals don’t have the facilities for colposcopy and you may have to visit a more specialised hospital in your area.

A colposcope is like a small microscope with a light and allows the nurse or doctor to make a thorough examination of the abnormal cells on the cervix.

Before your test you’ll be helped to position yourself on the couch. In the same way as when you had the screening test, the nurse or doctor will use a speculum to hold the vagina open. The doctor or nurse may repeat the screening test. A liquid is then dabbed onto the cervix to make the abnormal areas show up more clearly. A light is shone onto the cervix and the nurse or doctor looks through the colposcope to examine the area in detail. A small sample of surface cells (a biopsy) will be taken from the cervix and examined under a microscope by a pathologist. This can be uncomfortable and may cause a feeling like a period pain. The test takes between 15–20 minutes. You may have some slight bleeding for a few days afterwards.

Large loop excision of the transformation zone (LLETZ)

Abnormal cells are most likely to develop in an area of the cervix known as the transformation zone.| LLETZ is a common procedure which removes the abnormal cells in the transformation zone. Before the procedure a local anaesthetic is usually given. A thin wire is then used to cut away the affected area. The procedure may feel uncomfortable and it’s usual to have slight bleeding or discharge for a few days after this treatment. You may be asked not to use tampons or have sex for a month afterwards.

Cone biopsy

If the abnormal area can’t be seen properly with the colposcope, you may have a cone biopsy. This is done under a general anaesthetic, and you may need an overnight stay in hospital.

A small cone-shaped section of the cervix, which is large enough to contain the abnormal cells, is removed for examination under a microscope by a pathologist.

If there is just a very small growth of cancer cells (microinvasive cancer), the cone biopsy may remove it all so that no further treatment is needed. Even if the cone biopsy has not removed all of the cancer cells, it’s still helpful for your diagnosis, as it will help the doctors to decide on the right type of treatment for you.

 

After your cone biopsy

After the cone biopsy a gauze pack, like a tampon, may be placed in your vagina to prevent bleeding. This is usually removed within 24 hours. You may also have a thin tube, called a catheter, put into your bladder so that you can pass urine while the vaginal pack is in place. It’s normal to have some light bleeding for a few days after a cone biopsy. Strenuous physical activity and sex should be avoided for 4–6 weeks to allow the cervix to heal.

Sometimes a cone biopsy can make the cervix slightly weaker, which may increase the risk of miscarriage during pregnancy. In this situation, miscarriage can often be prevented by putting a stitch into the cervix during pregnancy to strengthen it. Your doctor can discuss this with you in more detail if you are concerned about possible future pregnancies. A cone biopsy will not affect your ability to enjoy sex.

The cervix can become very tightly closed after a cone biopsy, although this is extremely rare. This can make it harder for sperm to enter the womb and so can affect the chances of becoming pregnant naturally. If you are still having periods after your cone biopsy, this shows that your cervix is not completely closed.